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1

Anterior cruciate ligament injuries. Evaluation, arthroscopic reconstruction, and rehabilitation.  

PubMed

The advantages of arthroscopic reconstruction of the anterior cruciate ligament tear over arthrotomy are quite obvious: reduced pain and morbidity. Some arthroscopists are performing these procedures on an outpatient basis. The physician can choose from several graft substitutes for anterior cruciate ligament replacement. Autografts consisting of the iliotibial band, semitendinosus, gracilis, and meniscus have been used as grafts. The most common autograft is the bone-patellar tendon-bone, which has been used since 1930 and has been shown to have a tensile strength near that of the anterior cruciate ligament. The state of the art in surgical alternatives for anterior cruciate ligament tears is arthroscopic reconstruction using the midthird of the patellar tendon. Treatment of anterior cruciate ligament injuries requires prompt and adequate evaluation of the laxity of the ligament as well as other structures in the knee, appropriate treatment options offered to the patient with complete descriptions of knee function after each treatment option, and comprehensive rehabilitation program. Patient compliance is an integral part of the success of this procedure. The nurse must include a description of the injury, preoperative testing, surgical intervention, and rehabilitation program when educating the patient. The successful postoperative anterior cruciate ligament rehabilitation program is multifaceted. In general, there must be specific guidelines applied by a physical therapist who has knowledge of the surgical procedure, understands principles of ligament healing, and has the ability to individualize the program as needed. For any level of athlete or active person, there must be achievement of all goals per phase to a high performance level. In addition, there must always be objective measurements to document progress to the physical therapist and physician but, perhaps most importantly, to reassure the patient that normalcy is being restored. PMID:2000316

Whittington, C F; Carlson, C A

1991-03-01

2

Arthroscopic management of mucoid degeneration of anterior cruciate ligament  

PubMed Central

Background: Mucoid degeneration of the anterior cruciate ligament (ACL) is a less understood entity. The purpose of this study was to diagnose mucoid degeneration of anterior cruciate ligament and to assess the effectiveness of arthroscopic treatment in these patients. Materials and Methods: Between December 2007 and November 2011, 20 patients were diagnosed to be suffering from mucoid degeneration of anterior cruciate ligament (ACL) on the basis of magnetic resonance imaging (MRI), histopathology, and arthroscopy findings. 12 patients were males and 8 patients were females, with mean age of 42.2 years for males (range 28-52 years) and 39.4 years for females (range 30–54 years). They presented with pain on terminal extension (n=10) and on terminal flexion (n=2) without history of significant preceding trauma. MRI showed an increased signal in the substance of the ACL both in the T1- and T2-weighted images, with a mass-like configuration that was reported as a partial or complete tear of the ACL by the radiologist. At arthroscopy, the ACL was homogenous, bulbous, hypertrophied, and taut, occupying the entire intercondylar notch. A debulking of the ACL was performed by a judicious excision of the degenerated mucoid tissue, taking care to leave behind as much of the intact ACL as possible. Releasing it and performing a notchplasty treated impingement of the ACL to the roof and lateral wall. In one patient, we had to replace ACL due to insufficient tissue left behind to support the knee. Results: Good to excellent pain relief on terminal flexion–extension was obtained in 19 of 20 knees. The extension deficit was normalized in all knees. Lachman and anterior drawer test showed a firm endpoint in all, and 85% (n=17) showed good to excellent subjective satisfaction. Conclusions: Mucoid hypertrophy of the ACL should be suspected in elderly persons presenting pain on terminal extension or flexion without preceding trauma, especially when there is no associated meniscal lesion or ligamentous insufficiency. They respond well to a judicious arthroscopic release of the ACL with notchplasty.

Chudasama, Chirag H; Chudasama, Vyoma C; Prabhakar, Mukund M

2012-01-01

3

Massive Bone Loss from Fungal Infection after Anterior Cruciate Ligament Arthroscopic Reconstruction  

Microsoft Academic Search

Although there are numerous reports of septic pyogenic arthritis after arthroscopic anterior cruciate ligament (ACL) reconstruction,\\u000a there is limited information regarding the outcomes of fungal infection. We determined the outcomes of six patients with mycotic\\u000a infection after regular ACL reconstruction. There were four males and two females with a mean age of 33 years. We determined\\u000a the number of procedures performed,

D. Luis Muscolo; Lisandro Carbo; Luis A. Aponte-Tinao; Miguel A. Ayerza; Arturo Makino

2009-01-01

4

Arthroscopic Reconstruction of the Anterior Cruciate LigamentA Comparison of Patellar Tendon Autograft and Four-Strand Hamstring Tendon Autograft  

Microsoft Academic Search

We compared the outcome of anterior cruciate ligament reconstruction using hamstring tendon autograft with outcome using patellar tendon autograft at 2 years after surgery. Patients had an isolated anterior cruciate ligament injury and, apart from the grafts, the arthroscopic surgical technique was identical. Prospective assessment was performed on 90 patients with isolated anterior cruciate ligament injury undergoing reconstruction with a

Ian S. Corry; Jonathan M. Webb; Amanda J. Clingeleffer; Leo A. Pinczewski

1999-01-01

5

Arthroscopic reduction and fixation of avulsion fracture of the tibial attachment of the anterior cruciate ligament.  

PubMed

In treating avulsion fracture of the tibial attachment of the anterior cruciate ligament, surgical reduction and fixation of fractured bone is necessary for patients who have a wide displacement of bone fragment (i.e., types III and IV in the Meyers classification). Our arthroscopic technique allows the creation of bone tunnels on the medial and lateral sides of the bone fragment from the medial side of the tibial tubercle without using special equipment. At surgery, fixation wire is prepared into a loop, pulled into the joint space, and the loop is opened within the joint. This makes intra-articular manipulation easy, and the bone can be reduced more accurately. This arthroscopic technique decreases surgical invasion of the joint, allows good postoperative range of motion without problems, and is useful in preventing extension limitation due to dislocation of the anterior portion of the fragment. PMID:11694937

Hara, K; Kubo, T; Shimizu, C; Suginoshita, T; Hirasawa, Y

6

Five-Year Results of Single-Incision Arthroscopic Anterior Cruciate Ligament Reconstruction with Patellar Tendon Autograft  

Microsoft Academic Search

We performed a retrospective study on 80 patients who underwent single-incision arthroscopic anterior cruciate ligament reconstruction with patellar tendon autograft and interference fit screw fixation in 1989. Twelve patients were lost to followup, allowing a clinical assessment of 68 patients to be conducted by independent examiners at 1 and 5 years after surgery, with radiographic assessment at 5 years. Thirty-three

David Otto; Leo A. Pinczewski; Amanda Clingeleffer; Ross Odell

1998-01-01

7

The Arthroscopic Appearance of a Normal Anterior Cruciate Ligament in a Posterior Cruciate Ligament–Deficient Knee: The Posterolateral Bundle (PLB) Sign  

Microsoft Academic Search

Partial anterior cruciate ligament (ACL) tears that result in functional instability are usually the result of a deficiency of the anteromedial bundle (AMB), and are evident arthroscopically by a prominent posterolateral bundle (PLB). As double-bundle ACL reconstructions are being suggested to recreate a more normal anatomy, the roles of each bundle are being more critically questioned. We present a case

Anikar Chhabra; Boris A. Zelle; Matthew T. Feng; Freddie H. Fu

2005-01-01

8

Aperture fixation in arthroscopic anterior cruciate ligament double-bundle reconstruction.  

PubMed

The native anterior cruciate ligament (ACL) consists of 2 bundles, which have distinct biomechanical yet synergistic functions with respect to anterior tibial translation and combined rotatory loads. Traditionally, most ACL reconstruction techniques have primarily addressed the restoration of the anteromedial bundle, and less consideration was given to the posterolateral bundle. Recently, various ACL double-bundle reconstruction techniques have been described. With most of these techniques, however, an indirect extra-anatomic fixation far from the articular surface was performed. Because extra-anatomic fixation techniques, rather than aperture fixation techniques, are associated with graft tunnel motion, windshield wiper action, and suture stretch-out, concerns may arise regarding delayed biological incorporation, tunnel enlargement, and secondary rotational and anterior instability. We, therefore, present a novel arthroscopic technique that reapproximates the footprints of native ACL with the use of double-strand semitendinosus and gracilis autografts for reconstruction of the anteromedial and posterolateral bundles, respectively. A separate femoral and tibial tunnel is drilled for each double-strand autograft. The femoral tunnel for the anteromedial bundle is drilled primarily through a transtibial technique, and the femoral tunnel for the posterolateral bundle is drilled via an accessory anteromedial portal with the use of a 4-mm offset drill guide in the anteroinferior aspect of the femoral tunnel for the anteromedial bundle. Bioabsorbable interference screws are used in aperture fixation for anatomic fixation of each bundle. This technique attempts to reproduce closely the native ligament and its biomechanical function. PMID:17084308

Brucker, Peter U; Lorenz, Stephan; Imhoff, Andreas B

2006-09-11

9

Effects of biophysical stimulation in patients undergoing arthroscopic reconstruction of anterior cruciate ligament: prospective, randomized and double blind study  

Microsoft Academic Search

Pre-clinical studies have shown that treatment by pulsed electromagnetic fields (PEMFs) can limit the catabolic effects of\\u000a pro-inflammatory cytokines on articular cartilage and favour the anabolic activity of the chondrocytes. Anterior cruciate\\u000a ligament (ACL) reconstruction is usually performed by arthroscopic procedure that, even if minimally invasive, may elicit\\u000a an inflammatory joint reaction detrimental to articular cartilage. In this study the

Francesco Benazzo; Giacomo Zanon; Luigi Pederzini; Fulvio Modonesi; Carlo Cardile; Francesco Falez; Luigi Ciolli; Filippo La Cava; Sandro Giannini; Roberto Buda; Stefania Setti; Gaetano Caruso; Leo Massari

2008-01-01

10

Arthroscopic reconstruction of the anterior cruciate ligament with Leeds-Keio ligament in non-professional athletes  

Microsoft Academic Search

We report our experience using the Leeds-Keio artificial ligament for anterior cruciate ligament (ACL) reconstruction. The study relates the results of the first 40 patients subjected to arthroscopic reconstruction of the ACL with a Leeds-Keio ligament, with a mean follow-up of 73 months. No associated peripheral procedures were carried out on any patient. The average age of the patients at

M. Marcacci; S. Zaffagnini; A. Visani; F. Iacono; M. P. Neri; A. Petitto

1996-01-01

11

Transportal versus transtibial drilling technique of creating femoral tunnel in arthroscopic anterior cruciate ligament reconstruction using hamstring tendon autograft.  

PubMed

Drilling of femoral tunnel by transtibial technique is widely used in arthroscopic anterior cruciate ligament (ACL) reconstruction. Recent studies suggest in this technique graft is placed in non-anatomical position leading to instability. If the femoral tunnel is drilled through an anteromedial portal (transportal technique), graft can be placed more anatomically leading to better knee stability theoratically. The purpose of this study is to compare the clinical outcome of transtibial technique and transportal technique for drilling of femoral tunnel in arthroscopic ACL reconstruction using hamstring tendon autograft. All patients operated between January 2009 and September 2011 were approached for eligibility. Blinded assessment of IKDC score, Lachman test, pivot shift test, time of recovery from surgery were obtained from both the transtibial and transportal groups. The transportal group shows significantly better IKDC score, higher anteroposterior knee stability by Lachman test and lower recovery time from surgery. PMID:23785908

Mandal, Ananda; Shaw, Ranjit; Shaw, Ranjit Kumar; Biswas, Debasis; Basu, Anindya

2012-11-01

12

Arthroscopic-assisted anterior cruciate ligament reconstruction with the central third patellar tendonA 5–8-year follow-up  

Microsoft Academic Search

We reviewed 89 arthroscopically assisted patellar tendon anterior cruciate ligament (ACL) reconstructions for chronic isolated\\u000a injuries with an average follow-up of 7 years (range 5.4 to 8.6 years). Pain was present in 7 knees (8%). Giving-way symptoms\\u000a were reported by 7 patients (8%). A KT-2000 side-to-side difference over 5 mm at 30 lbs was recorded in 12 cases (16%). The

P. Aglietti; R. Buzzi; F. Giron; A. J. V. Simeone; G. Zaccherotti

1997-01-01

13

Massive Proximal Extravasation as a Complication during Arthroscopic Anterior Cruciate Ligament Reconstruction  

PubMed Central

Extra-articular extravasation of irrigation fluid is relatively common around entry incisions and is usually limited to the subcutaneous tissue. Very rarely, extravasation occurs above the knee, in the thigh and even up into the pelvis. We are reporting the second case of irrigation fluid extravasation during a knee arthroscopy, which spread up to the thigh, groin and perineum during anterior cruciate ligament reconstruction, whilst the tourniquet was inflated. In our case, we think that the extravasation was caused by a fault in the pressure sensor due to the fact that the reservoir was over-filled. The irrigation pressure was therefore too high, and the irrigation fluid was able to diffuse, despite the presence of a pneumatic tourniquet, up past the thigh.

Pailhe, Regis; Reina, Nicolas; Chiron, Philippe; Laffosse, Jean-Michel

2013-01-01

14

Arthroscopic treatment for tibial "Peel off" tears in anterior cruciate ligament-case report.  

PubMed

Anterior cruciate ligament (ACL) injury was very common, and its reconstruction is one of the most commonly performed orthopaedic surgeries. A standard treatment option for ACL complete rupture in active young patients is debridement of remnant tissue and reconstruction with various types of tendon graft. However, "A tibial peel off tear" of ACL without bony avulsion can be treated using preservation of original ACL and trans-osseous pullout suture repair. The IKDC subjective score was 90, the objective score was A, and the Lysholm score was 95 at 24 months after surgery. KT-2000 arthrometer showed 2 mm side-to-side difference. Pivot shift test and Lachman test were negative, and there was no limitation in range of motion. Patient returned to full activities including sports and satisfied with the surgical results. In the postoperative MRI at 6 months after the surgery, the continuity of ACL was well maintained without any Cyclops lesion. We believe that trans-osseous pullout suture repair could be included as an alternative method in this "tibial peel off" type ACL injury instead of the usual removal of remnant tissue and reconstruction with a graft. PMID:23412240

Ahn, Jin Hwan; Han, Kye Young; Yu, In Sang; Koh, Kyoung Hwan

2012-10-27

15

Preconditioning patellar tendon autografts in arthroscopic anterior cruciate ligament reconstruction: a prospective randomized study.  

PubMed

This prospective randomized evaluated the effect of preconditioning patellar tendon autografts before implantation and fixation during anterior cruciate ligament (ACL) reconstruction. Fifty-three patients with a unilateral ACL rupture were included in the study. One group of patients had their patellar tendon autograft preconditioned by passive stretching at a constant load of 39 N for 10 min immediately prior to implantation (group P). The other group underwent no preconditioning before the implantation of the graft (group NP). The follow-up examination was performed by independent observers after 26 months (23-29) in group P and after 25 months (23-30) in group NP (n.s.). At follow-up the KT-1000 laxity test revealed a total side-to-side difference of 2.5 mm (-1.5 to +8.5) in group P and 3.0 mm (-7 to +6.5) in group NP (n.s.). The Lysholm score was 86 points (47-100) in group P and 94 points (44-100) in group NP (n.s.). The Tegner activity level was 6 (2-9) in group P and 7 (3-9) in group NP (n.s.). There was no significant difference between the study groups regarding IKDC classification. Patients who underwent ACL reconstruction using a preconditioned patellar tendon autograft had no advantages in terms of restoration of laxity or clinical outcome at 2-year follow-up. PMID:11269585

Ejerhed, L; Kartus, J; Köhler, K; Sernert, N; Brandsson, S; Karlsson, J

2001-01-01

16

Anterior cruciate ligament arthroplasty  

Microsoft Academic Search

A unique augmentation arthroplasty has evolved from a retrospective review of 150 anterior cruciate ligament (ACL) repairs, extracapsular substitutions, and pes an serine transfers. This coincided with a proposed patho logic relationship seen in surgical exposures of the femoral intercondylar notch. From 1976 to 1983, 544 cases with known ACL insufficiency were selected for study. In 397 subsequent anterior cruciate

David A. Kieffer; Robert J. Curnow; Richard B. Southwell; William F. Tucker; Katherine K. Kendrick

1984-01-01

17

Arthroscopically Assisted Semitendinosus and Gracilis Tendon Graft in Reconstruction for Acute Anterior Cruciate Ligament Injuries in Athletes  

Microsoft Academic Search

We evaluated 69 arthroscopically assisted anterior cru ciate ligament reconstructions for acute tears at an average followup of 60 months. We used a distally based single semitendinosus and gracilis tendon graft passed over the top and fixed to the femur. Combined medial collateral ligament lesions were seen in 30 knees, and they were repaired when found in the distal third

Paolo Aglietti; Roberto Buzzi; Pier Paolo M. Menchetti; Francesco Giron

1996-01-01

18

Arthroscopically assisted reduction and internal fixation of a femoral anterior cruciate ligament osteochondral avulsion fracture in a 14-year-old girl via transphyseal inside-out technique.  

PubMed

Femoral avulsion fracture of the anterior cruciate ligament (ACL) in children and adolescents is rare, and its arthroscopic treatment is even more so. A femoral avulsion fracture of the ACL of a 14-year-old girl was arthroscopically reduced and fixed by a Kirschner wire (K-wire) via an inside-out technique. A 1.4-mm K-wire was drilled inside-out into the osseous defect of the lateral femoral condyle under arthroscopic visualization. The avulsed fragment was reduced and then drilled retrograde by the wire. After bending the intra-articular visible end of the K-wire by a knot pusher, the fragment was gently fixed by pulling the wire from outside. At 24 months, both knee stability and range of motion were the same in the operated and the healthy opposite leg. Magnetic resonance imaging evaluation and conventional radiographs showed an intact ACL without detectable disturbance in the growth plate. Only seven cases of a proximal avulsion of the ACL in children and adolescents have been published. Six were treated by open reduction and internal fixation, one by arthroscopic reduction without fixation. PMID:24002803

Langenhan, Ronny; Baumann, Matthias; Hohendorff, Bernd; Probst, Axel; Trobisch, Per

2013-09-04

19

The comparison effects of intra-articular injection of different opioids on postoperative pain relieve after arthroscopic anterior cruciate ligament reconstruction: A randomized clinical trial study*  

PubMed Central

BACKGROUND: Pain after knee surgery, if not relieved, it would lead to a more severe and prolonged pain that can delay the patients recovery and rehabilitation. The effect of pain relief by some drugs after intra-articular injection has been shown. This study compared the effect of intra-articular injection of opioids (morphine, pethidine, methadone, and tramadol) on postoperative relieving pain after arthroscopic anterior cruciate ligament (ACL) reconstruction. METHODS: 150 candidate patients for knee arthroscopic ACL reconstruction were randomly enrolled into five groups. At the end of the procedure, all patients in each group received a joint injection solution including 9.5 millimeters bupivacaine with 1:200,000 epinephrine. The remaining 0.5 milliliters of syringe capacity was filled with one of the five solutions listed below: methadone group I: 5 mg methadone, morphine group II: 5 mg morphine, pethidine group III: 37.5 mg pethidine, tramadol group IV: 100 mg Tramadol, and control group V: 0.5 ml normal saline. Afterwards, any drug further administered to the patients based on need was recorded, and the morphine equivalent for all drugs was calculated. Patients need to narcotic drugs during the first twelve hours of hospitalization and pain scores were recorded. After data gathering, they were analyzed by SPSS 16 software with chi-Square, Kruskal-Wallis and ANOVA statistical tests. RESULTS: The highest and the lowest significant pain intensity were seen in placebo and morphine groups, respectively, in the first, second and third 4 hours after surgery. There were significant differences among the groups for need to analgesics. In other words, placebo group needed the highest dosage of analgesics and morphine and methadone groups needed the lowest dosage of analgesics. Morphine and methadone groups had maximum and minimum response to pain, respectively, in the first, second and third 4 hours after surgery. CONCLUSIONS: Administering 5 mg intra-articular morphine after arthroscopic ACL reconstruction is a valuable choice and is recommended to be added to other local anesthetics administrated drugs after this procedure.

Arti, Hamidreza; Mehdinasab, Seyed Abdoulhossein

2011-01-01

20

A Five-Year Comparison of Patellar Tendon Versus Four-Strand Hamstring Tendon Autograft for Arthroscopic Reconstruction of the Anterior Cruciate Ligament  

Microsoft Academic Search

Background: The choice of graft material for anterior cruciate ligament reconstruction is believed to play a major role in outcome, but most comparisons of graft choice have not been well controlled.Hypothesis: The choice of graft material (patellar tendon or hamstring tendon) does affect clinical outcome after anterior cruciate ligament reconstruction.Study Design: Prospective, nonrandomized clinical trial.Methods: Two groups of 90 patients

Leo A. Pinczewski; David J. Deehan; Lucy J. Salmon; Vivianne J. Russell; Amanda Clingeleffer

2002-01-01

21

Lateral meniscal tears and their evolution in acute injuries of the anterior cruciate ligament of the kneeArthroscopic analysis  

Microsoft Academic Search

Arthroscopic diagnosis was used to determine the incidence of the most frequent injuries to the knee’s internal structures\\u000a associated with ACL tear as well as ones without ACL tear. The most frequent finding associated with a recent ACL tear was\\u000a the LM tear (72.7%). There is a statistically significant incidence of recent LM tear in knees with a recent ACL

Dragan K. Nikoli?

1998-01-01

22

Magnetic resonance imaging of anterior cruciate ligament rupture  

Microsoft Academic Search

BACKGROUND: Magnetic resonance (MR) imaging is a useful diagnostic tool for the assessment of knee joint injury. Anterior cruciate ligament repair is a commonly performed orthopaedic procedure. This paper examines the concordance between MR imaging and arthroscopic findings. METHODS: Between February, 1996 and February, 1998, 48 patients who underwent magnetic resonance (MR) imaging of the knee were reported to have

Kai-Jow Tsai; Hongsen Chiang; Ching-Chuan Jiang

2004-01-01

23

MRI diagnosis of partial tears of the anterior cruciate ligament  

Microsoft Academic Search

In an attempt to define the magnetic resonance imaging (MRI) features of partial tears of the anterior cruciate ligament (ACL) we retrospectively analysed the MRI scans of 30 patients with a recent arthroscopic finding of a normal, a partial or a completely torn ACL. On review of the original reports MRI correctly predicted 99 (100 per cent) complete ACL tears,

J. A. L. Lawrance; S. J. Ostlere; C. A. F. Dodd

1996-01-01

24

Extracellular matrix content of ruptured anterior cruciate ligament tissue  

Microsoft Academic Search

Anterior cruciate ligaments (ACLs) can rupture with simple movements, suggesting that structural changes in the ligament may reduce the loading capacity of the ligament. We aimed to investigate if proteoglycan and collagen levels were different between ruptured and non-ruptured ACLs. We also compared changes in ruptured tissue over time.During arthroscopic knee reconstruction surgery 24 ruptured ACLs were collected from participants

Kate Young; Tom Samiric; Julian Feller; Jill Cook

2011-01-01

25

Magnetic resonance imaging of anterior cruciate ligament tears: reevaluation of quantitative parameters and imaging findings including a simplified method for measuring the anterior cruciate ligament angle  

Microsoft Academic Search

We evaluated the diagnostic utility of magnetic resonance imaging (MRI) for predicting anterior cruciate ligament (ACL) tears using both quantitative parameters and nonquantitative imaging findings. MRI examinations were retrospectively evaluated in a group of patients with arthroscopically confirmed complete ACL tear and in a control group with arthroscopically confirmed intact ACL. We evaluated multiple MRI features to compare their sensitivity

J. M. Mellado; J. Calmet; M. Olona; J. Giné; A. Saurí

2004-01-01

26

Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption  

Microsoft Academic Search

Instrumented anterior\\/posterior laxity measurements were performed on 138 patients evaluated within 2 weeks of injury with their first traumatic knee hemar throsis. All patients were tested with the MEDmetric Arthrometer model KT-1000 in a knee injury clinic. Seventy-five of the patients had knee arthroscopy. Thirty-three had arthrometer laxity tests under anes thesia. Eighty-seven percent of patients arthroscoped had anterior cruciate

Dale M. Daniel; Mary Lou Stone; Raymond Sachs; Lawrence Malcom

1985-01-01

27

Postoperative analgesic effects of an external cooling system and intra-articular bupivacaine\\/morphine after arthroscopic cruciate ligament surgery  

Microsoft Academic Search

The aim of this study was to evaluate the analgesic effect of an external cooling system with or without the combined effect of intra-articularly administered bupivacaine\\/morphine after arthroscopic anterior cruciate ligament (ACL) reconstruction. Fifty patients with isolated ACL insufficiency operated on under general anaesthesia were randomized to three different postoperative treatment groups. Group I was treated with the cooling system

Sveinbjörn Brandsson; Bengt Rydgren; Thomas Hedner; Olof Lundin; Leif Sward; Jon Karlsson

1996-01-01

28

A long-term study of anterior cruciate ligament allograft reconstruction  

Microsoft Academic Search

We retrospectively reviewed the long-term clinical outcome of unilateral arthroscopic anterior cruciate ligament (ACL) allograft\\u000a reconstruction. From October 1995 to December 1997, 64 arthroscopic ACL reconstructions were performed. Multiligamentous knee\\u000a injuries and ACL injuries in polytrauma patients were excluded and out of the remaining 60 patients 55 were available for\\u000a follow-up. Three patients had suffered a rerupture caused by major

K. F. Almqvist; Pieter Willaert; S. De Brabandere; K. Criel; R. Verdonk

2009-01-01

29

The future of anterior cruciate ligament surgery.  

PubMed

Future anterior cruciate ligament surgery techniques will evolve from emphasizing the technical factors involved in successful ligament reconstruction to emphasizing the biomechanical, neuromuscular, and biologic factors, which will enhance healing. Advances in computer and robotic technology will help the surgeon perform anterior cruciate ligament reconstruction. The importance of the anterior cruciate ligament and its relationship with other anatomic and neuromuscular structures of the knee has been well researched over the past decade; the next decade will combine this knowledge with technological and biological advancements. PMID:11845023

Kaplan, Lee D; Fu, Freddie H

2002-03-01

30

Trends in surgeon preferences on anterior cruciate ligament reconstructive techniques.  

PubMed

Many surgeons intend to replicate the native anterior cruciate ligament (ACL) as much as possible, aiming at anatomic ACL reconstruction. An outline of new surgical preferences is starting to form; orthopedic surgeons have shifted their preferences in arthroscopic technique, graft type, and fixation during the past decade. The days of simple silk suturing of the native ACL stump to the femoral periosteum are over. Today, knee surgeons performing ACL reconstruction have a wide array of technical considerations, graft choices, and fixation techniques at hand that enable them to specifically tailor each reconstruction to each patient's anatomy and specific needs. PMID:23177466

Samuelsson, Kristian; Andersson, Daniel; Ahldén, Mattias; Fu, Freddie H; Musahl, Volker; Karlsson, Jón

2012-09-21

31

Femoral block provides superior analgesia compared with intra-articular ropivacaine after anterior cruciate ligament reconstruction  

Microsoft Academic Search

Background and Objectives: Arthroscopic anterior cruciate ligament (ACL) reconstruction of the knee is a painful procedure requiring intensive postoperative pain management. This prospective study investigates analgesic quality after a femoral block as compared with intra-articular injection of local anesthetic. Methods: Eighty patients scheduled for elective ACL repair under general anesthesia were included in our study. Upon completion of surgery, the

Henri Iskandar; Antoine Benard; Joelle Ruel-Raymond; Gyslaine Cochard; Bertrand Manaud

2003-01-01

32

Single-incision technique misses the anatomical femoral anterior cruciate ligament insertion: a cadaver study  

Microsoft Academic Search

We examined the arthroscopic appearance of the anterior cruciate ligament (ACL) attachment site on the femur in five fresh-frozen cadaver knees. First, the ACL was cut out, leaving a footprint of ligament-fibers with a length of 2 mm intact. The ACL was consistently found to insert on the lateral wall of the notch. No fibers were found to attach high

Markus P. Arnold; Jan Kooloos; Albert van Kampen

2001-01-01

33

Continuous-flow cold therapy for outpatient anterior cruciate ligament reconstruction  

Microsoft Academic Search

This prospective, randomized study evaluated continuous-flow cold therapy for postoperative pain in outpatient arthroscopic anterior cruciate ligament (ACL) reconstructions. In group 1, cold therapy was constant for 3 days then as needed in days 4 through 7. Group 2 had no cold therapy. Evaluations and diaries were kept at 1, 2, and 8 hours after surgery, and then daily. Pain

FA Barber; DA McGuire; S Click

1998-01-01

34

Comparison of oral ketorolac and hydrocodone for pain relief after anterior cruciate ligament reconstruction  

Microsoft Academic Search

The analgesic effectiveness of ketorolac tromethamine was compared with hydrocodone and acetaminophen for pain from an arthroscopically assisted patellar-tendon autograft anterior cruciate ligament reconstruction. There were 125 patients evaluated in a double-blind, randomized, multicenter, and multidose study. A loading dose of parental ketorolac tromethamine was administered and subjects were later given two staged doses of the same \\

FA Barber; DE Gladu

1998-01-01

35

Reconstruction of the anterior cruciate ligament using a torn meniscus.  

PubMed

In eighty of 100 patients, reconstruction of the anterior cruciate ligament using a torn meniscus was successful in restoring stability. The length of follow-up ranged from two to six years and the mean interval from injury to operation was two years. Preoperatively, all but one patient had a positive (2+ or 3+) Lachman test and a positive pivot-shift test. Only ten patients had evidence of major instability, as seen on either test. The result was the same regardless of whether the patient had had a concomitant extra-articular (Ellison) procedure. The results of arthroscopic biopsy in eleven patients did not support the hypothesis that the meniscus underwent metaplasia to ligamentous tissue. Although this procedure yielded results similar to those of other procedures in which autogenous tissues are used to reconstruct the ligament, the meniscus should rarely, if ever, be used for reconstruction of the anterior cruciate ligament. The procedure is indicated only for patients who, in addition to needing reconstruction of the anterior cruciate ligament, also have a torn meniscus that would otherwise have to be totally excised. PMID:3392066

Ferkel, R D; Fox, J M; Del Pizzo, W; Friedman, M J; Snyder, S J; Dorey, F; Kasimian, D

1988-06-01

36

Anterior Cruciate Ligament Graft Choices  

PubMed Central

Context: Reconstruction of the anterior cruciate ligament (ACL) is a common surgical procedure; however, there is no consensus to what the best graft option is to replace the injured ACL. The main options available consist of allografts and autografts, which include patellar tendon, hamstring tendon, and quadriceps tendon autografts. Evidence Acquisition: The PubMed database was searched in August 2010 for English-language articles pertaining to ACL grafts. Results: Postoperative outcome variables were analyzed to determine similarities and differences among the different graft options. These variables include stability, strength, function, return to sports, patient satisfaction, complications, and cost. Conclusions: Both allografts and the 3 main options for autografts can provide excellent results in ACL reconstruction and lead to a high percentage of satisfied patients. However, differences exist among the graft choices. Both the similarities and the differences are important to discuss with a patient who will be undergoing ACL reconstruction so that he or she has the best information available when making a choice of graft.

Macaulay, Alec A.; Perfetti, Dean C.; Levine, William N.

2012-01-01

37

Popliteal artery laceration during arthroscopic posterior cruciate ligament reconstruction.  

PubMed

We report a case of acute laceration of the popliteal artery during an arthroscopic posterior cruciate ligament reconstruction. This injury can occur during the creation of the posteromedial portal, the manipulation of the tissues in the posterior part of the capsule of the knee joint, or when drilling the tibial hole. We recommend that a qualified vascular surgeon should be immediately available at the time of the surgery. In case of suspecting the occurrence of a popliteal artery injury, the vascular surgeon should be immediately consulted and arteriography and vascular repair should be performed. PMID:16325093

Makino, Arturo; Costa-Paz, Matias; Aponte-Tinao, Luis; Ayerza, Miguel A; Muscolo, D Luis

2005-11-01

38

Approaching the ruptured anterior cruciate ligament  

Microsoft Academic Search

Anterior cruciate ligament (ACL) disruptions are common injuries that currently hold a fearsome reputation among athletes of all abilities and disciplines. Indeed, if the diagnosis is missed at first presentation, it is difficult to attribute ongoing instability and recurrent injury to an ACL tear. Classically, patients then often improve shortly before repeatedly reinjuring their knee. At some point, the knee

Khaled M Sarraf; Amir Sadri; Gowreeson Thevendran; Vikas Vedi

2010-01-01

39

Graft healing in anterior cruciate ligament reconstruction  

Microsoft Academic Search

Successful anterior cruciate ligament reconstruction with a tendon graft necessitates solid healing of the tendon graft in the bone tunnel. Improvement of graft healing to bone is crucial for facilitating an early and aggressive rehabilitation and ensuring rapid return to pre-injury levels activity. Tendon graft healing in a bone tunnel requires bone ingrowth into the tendon. Indirect Sharpey fiber formation

Chih-Hwa Chen

2009-01-01

40

Brucella arthritis of the knee, 1 year after revision of anterior cruciate ligament reconstruction  

PubMed Central

Brucellosis is a zoonotic infection with a broad spectrum of clinical manifestations. The authors report the first case in the literature of septic arthritis of the knee 1 year after revision of anterior cruciate ligament reconstruction. Brucella melitensis biotype 3 was found in both synovial fluid and blood cultures. The patient was treated initially with arthroscopic debridement. After the diagnosis was confirmed, a second arthroscopic lavage and metal work removal was applied leaving the graft in place. Antimicrobial chemotherapy was prescribed for 3 months. The infection was fully eradicated and the patient is still asymptomatic, 4 years after the treatment.

Papastergiou, S G; Koukoulias, N E; Koumis, P; Kyparlis, D; Santas, R

2011-01-01

41

Surgical Management of Anterior Cruciate Ligament Injuries  

Microsoft Academic Search

An anterior cruciate ligament (ACL) injury produces an athletic disability that is the most common knee injury to require\\u000a a ligament reconstruction. Recent research has contributed to a better understanding of all aspects of this injury, but it\\u000a is particularly in the areas of kinematics, graft placement, and graft fixation that the greatest improvements have occurred.\\u000a Controversy abounds in the

Mark E. Steiner

42

[Infection after anterior cruciate ligament reconstruction: grave error in treatment?].  

PubMed

A 28-year-old patient showed clear signs of knee joint infection 8 days after arthroscopic reconstruction of the anterior cruciate ligament. The treating physicians recommended further observation although they stated that a knee joint infection could not be reliably excluded. One week later arthroscopic revision was performed and intraoperative smear tests showed infection by Pseudomonas aeruginosa. Therefore, another 6 days later the obviously infected transplant had to be removed. In the long run painful and limited range of motion of the affected knee joint persisted. The patient complained about medical malpractice concerning management of the complication. The expert opinion stated that due to the fateful course of infection the tendon graft could not be retrieved after the eighth day post surgery anyway. Thus, only flawed delay of treatment was criticized. The arbitration board argued, however, that scientific data concerning the fate of infected tendon grafts do not support the expert opinion and that immediate arthroscopy and antibiotic treatment at least had the potential to influence the course of infection in a positive manner. Evidence clearly shows that survival of an infected tendon graft depends on early diagnosis and emergency treatment rather than just on fate. Due to the fact that, although having in mind the possibility of a knee joint infection, the necessary therapy was delayed for 8 days, the arbitration board considered the described medical malpractice a severe treatment error, leading to reversal of evidence in favour of the patient. PMID:22706649

Regauer, M; Neu, J

2012-09-01

43

Pre and postoperative intra-articular analgesia for arthroscopic surgery of the knee and arthroscopy-assisted anterior cruciate ligament reconstructionA double-blind randomized, prospective study  

Microsoft Academic Search

We tested the effectiveness of different intra-articular analgesics and of pre-emptive intra-articular analgesia for arthroscopy-assisted\\u000a anterior cruciate ligament reconstruction (ACLR) and for operative knee arthroscopy. Eighty-two patients underwent operative\\u000a knee arthroscopy under selective subarachnoid anaesthesia (group A), and 60 patients underwent arthroscopy-assisted ACLR under\\u000a general anaesthesia (group B). Patients were randomly assigned to intra-articular analgesic treatment as follows. Group A:

M. Denti; P. Randelli; M. Bigoni; G. Vitale; M. R. Marino; N. Fraschini

1997-01-01

44

Fifteen-Year Outcome of Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft for ‘‘Isolated’’ Anterior Cruciate Ligament Tear  

Microsoft Academic Search

Background: Few studies report the long-term results of anterior cruciate ligament rupture and single-incision endoscopic reconstructive surgery. Outcomes are often clouded by concomitant meniscal, chondral, or ligament injuries.Purpose: To determine the 15-year outcomes of anterior cruciate ligament ruptures treated with endoscopic anterior cruciate ligament reconstruction using middle-third patellar tendon autograft.Study Design: Case series; Level of evidence, 4.Methods: Between January 1993

Catherine Hui; Lucy J. Salmon; Alison Kok; Shinichi Maeno; James Linklater; Leo A. Pinczewski

2011-01-01

45

Lateral thrust of anterior cruciate ligament-insufficient knees and posterior cruciate ligament-insufficient knees  

Microsoft Academic Search

Leaving anterior cruciate ligament (ACL) insufficiency and posterior cruciate ligament (PCL) insufficiency untreated frequently leads to osteoarthritis (OA). The purpose of this study was to evaluate dynamically the lateral thrust of ACL-insufficient knees and PCL-insufficient knees, and from the findings investigate the relationship between cruciate ligament insufficiency and OA occurrence. An acceleration sensor was attached to the affected and control

Ichiro Yoshimura; Masatoshi Naito; Jingfan Zhang

2002-01-01

46

Transphyseal Anterior Cruciate Ligament Reconstruction Using Mesenchymal Stem Cells  

Microsoft Academic Search

Background: Conventional techniques for reconstruction of the anterior cruciate ligament in skeletally immature patients risk potential iatrogenic growth disturbance because of drilling across the physis. Animal models have demonstrated mixed results regarding growth disturbances from soft tissue grafts across the physis.Hypothesis: Mesenchymal stem cells derived from bone marrow may be effective in preventing growth arrest after intra-articular anterior cruciate ligament

John R. Babb; Jae I. Ahn; Frederick M. Azar; S. Terry Canale; James H. Beaty

2008-01-01

47

Anterior Cruciate Ligament Revision ReconstructionResults in 107 Patients  

Microsoft Academic Search

Background: Although techniques and options for suitable graft substitutes for anterior cruciate ligament surgery continue to improve, failures occur because of many reasons. Errors in surgical techniques seem to be important reasons.Hypothesis: Inappropriate positioning of the tunnels may be the most important reason for these failures. Anatomical anterior cruciate ligament revision reconstruction, using autografts, may yield acceptable outcomes.Study design: Case

Andreas P. Diamantopoulos; Olaf Lorbach; Hans H. Paessler

2008-01-01

48

Simultaneous bicompartmental bucket-handle meniscal tears with intact anterior cruciate ligament: a case report  

PubMed Central

Introduction Bucket handle tear of the menisci is a common type of lesion resulting from injury to the knee joint. Bucket handle injury of both menisci in almost all cases is associated with a lesion to either the anterior or the posterior cruciate ligament of the knee joint. We describe a case of acute bucket-handle tear of the medial and lateral menisci with intact anterior and posterior cruciate ligaments in a dancer. To the best of our knowledge, there are no previous reports of this type of injury in the literature. Case presentation A 28-year-old Caucasian Greek woman presented to the emergency department after sustaining an injury to her right knee during dancing. An MRI evaluation demonstrated tears in both menisci of the right knee, while the anterior and posterior cruciate ligaments were found to be intact. A partial medial and lateral meniscectomy was then performed. At a follow-up examination six months after her injury, clinical tests demonstrated that our patient's right knee was stable, had a full range of motion and had no tenderness. She was satisfied with the outcome of the operation and returned to her pre-injury activities. Conclusion We present the first case in the literature that describes a combined bucket-handle injury of both the medial and lateral menisci with an intact anterior cruciate ligament. The clinical examination of the anterior cruciate ligament was unremarkable, with no signs of deficiency or rupture. The posterior cruciate ligament was also intact. On magnetic resonance imaging, the ligaments were visualised as intact in all their length. These findings were confirmed by arthroscopic evaluation.

2010-01-01

49

Risk Factors for Anterior Cruciate Ligament Injury  

PubMed Central

Context: Injuries to the anterior cruciate ligament (ACL) are immediately disabling and are associated with long-term consequences, such as posttraumatic osteoarthritis. It is important to have a comprehensive understanding of all possible risk factors for ACL injury to identify individuals who are at risk for future injuries and to provide an appropriate level of counseling and programs for prevention. Objective: This review, part 2 of a 2-part series, highlights what is known and still unknown regarding hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors for ACL injury. Data Sources: Studies were identified from MEDLINE (1951–March 2011) using the MeSH terms anterior cruciate ligament, knee injury, and risk factors. The bibliographies of relevant articles and reviews were cross-referenced to complete the search. Study Selection: Prognostic case-control and prospective cohort study designs to evaluate risk factors for ACL injury were included in this review. Results: A total of 50 case-control and prospective cohort articles were included in parts 1 and 2. Twenty-one focused on hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors. Conclusions: Several risk factors are associated with increased risk of suffering ACL injury—such as female sex, prior reconstruction of the ACL, and familial predisposition. These risk factors most likely act in combination with the anatomic factors reviewed in part 1 of this series to influence the risk of suffering ACL injury.

Smith, Helen C.; Vacek, Pamela; Johnson, Robert J.; Slauterbeck, James R.; Hashemi, Javad; Shultz, Sandra; Beynnon, Bruce D.

2012-01-01

50

Translational studies in anterior cruciate ligament repair.  

PubMed

Translational research, which can be explained as the principle of combining advances in both basic research and clinical understanding in a bedside-to-bench-to-bedside approach, has become one of the central themes of present-day medical research. One orthopedic problem that has strongly benefited from such an approach is tissue-engineering-enhanced primary repair of the anterior cruciate ligament. Recent years have shown a clearer definition of the clinical problem and established an underlying mechanistic cause of the incapacity of the anterior cruciate ligament to heal-the premature loss of provisional scaffold in the wound site. These clinical findings were then translated into a research objective, namely, to replace the missing scaffold with a biomaterial with appropriate structural and bio-stimulatory characteristics. Subsequently, a tissue-engineering-based treatment using a collagen-platelet composite was developed and tested in vitro. After proofing the efficacy of this new treatment in the laboratory, it was translated into a potential clinical application, which showed highly successful results in structural integrity and biomechanical capacity in large animal testing. This approach of defining the scientific mechanism underlying a clinical observation and then using that information to design new therapies is but one example of how translational research in tissue engineering can help define and develop new treatments for challenging problems faced by patients. PMID:20143926

Vavken, Patrick; Murray, Martha M

2010-02-01

51

Prospective Correlation Between Serum Relaxin Concentration and Anterior Cruciate Ligament Tears Among Elite Collegiate Female Athletes  

Microsoft Academic Search

Background: The female anterior cruciate ligament may be more susceptible to injury than the male anterior cruciate ligament because of the gender-specific expression of receptors for relaxin, a collagenolytic hormone that promotes remodeling of the anterior cruciate ligament.Purpose: This study was undertaken to investigate whether collegiate female athletes with elevated serum relaxin concentrations (SRC) sustain anterior cruciate ligament tears at

Jason L. Dragoo; Tiffany N. Castillo; Hillary J. Braun; Bethany A. Ridley; Ashleigh C. Kennedy; S. Raymond Golish

2011-01-01

52

[Manipulation and preparation of Achilles allograft for reconstruction of anterior and posterior cruciate ligament].  

PubMed

Cruciate ligament reconstruction surgery, both anterior and posterior, by arthroscopic technique is increasingly used today. We present the systematic handling and preparation of the Achilles allograft ligamentoplasty for use in anterior and posterior Cruciate ligaments performed by our team since 2000 in 45 cases. The use of tissues from tissue banks allows increasingly more difficult surgeries to be performed. The cases of reconstruction of anterior cruciate ligament are increasing due to the increased number of patients on whom the first step is performed. The reconstruction of posterior cruciate ligament is being performed in an increasing number of cases due to allografts being larger and thicker than autografts. The systematic management of grafts coming from tissue banks requires a systemic protocol for the safety of the receptor patient. All systematic handling and preparation of the Achilles allograft presented in this work is performed by the nurse-or-instrumentalist, not only in the management and safety of the grafts, but there is also a circulating nurse available in the background, who also is important. According to NIC the operations than can be performed by nursing are: * Surgical care. Definition: Assisting the surgeon in the operative procedure on the part of/the instrumentalist. * Surgical precautions. Definition: minimize the possibility of iatrogenic injury to the patient involved in a surgical procedure. PMID:20656538

Gimeno, Anna; Navarro, Jordi; Tejero, Paqui; Seijas, Roberto; Cuscó, Xavier; Ares, Oscar; Cugat, Ramón

2010-07-24

53

Risk of Tearing the Intact Anterior Cruciate Ligament in the Contralateral Knee and Rupturing the Anterior Cruciate Ligament Graft During the First 2 Years After Anterior Cruciate Ligament ReconstructionA Prospective MOON Cohort Study  

Microsoft Academic Search

Background: The risk of tear of the intact anterior cruciate ligament in the contralateral knee after anterior cruciate ligament reconstruction of the opposite knee and the incidence of rupturing the anterior cruciate ligament graft during the first 2 years after surgery have not been extensively studied in a prospective manner. Clinicians have hypothesized that the opposite normal knee is at

Rick W. Wright; Warren R. Dunn; Annunziato Amendola; Jack T. Andrish; John Bergfeld; Christopher C. Kaeding; Robert G. Marx; Eric C. McCarty; Richard D. Parker; Michelle Wolcott; Brian R. Wolf; Kurt P. Spindler

2007-01-01

54

Gore-Tex prosthetic ligament in anterior cruciate deficient knees  

Microsoft Academic Search

Reconstruction for symptomatic anterior cruciate defi cient knees has yielded varying success rates. Pros thetic cruciate replacement has recently become a po tentially attractive alternative. The results of the Gore- Tex polytetrafluoroethylene ligament, which is intended as a permanent replacement, are reported.Eighty-two patients were followed prospectively, mean age was 28 years (range, 16 to 51 years) and mean followup was

Ronald Glousman; Clarence Shields; Robert Kerlan; Frank Jobe; Stephen Lombardo; Lewis Yocum; James Tibone; Ralph Gambardella

1988-01-01

55

Anterior cruciate ligament injuries among wakeboarders: a case report.  

PubMed

No previous cases of anterior cruciate ligament (ACL) injuries sustained during wake-boarding have been reported. We report on a case involving an ACL injury sustained during wakeboarding. A 27-year-old man sustained an injury while attempting a wakeboarding maneuver(a heel-side back roll, consisting of a jump and simultaneous roll toward the heel side). He failed to complete his roll before landing, striking the water with his right shoulder foremost, then plunging underwater. When his wakeboard struck the water, his left knee was sprained by the rotational force exerted by the board. The patient was diagnosed with an isolated ACL injury and underwent arthroscopic ACL reconstructive surgery. The board used in wakeboarding is wider and subject to greater water resistance than that used in water skiing. The feet of the wakeboarder are firmly attached by binding boots to a board, laterally with respect to the direction of motion, impeding easy separation of the board from the feet in the event of a fall. Thus, wakeboarding conditions would appear to put wakeboarders at particular risk for ACL injuries. These conditions need be assessed from a medical perspective in order to devise ways to minimize the risk of such injuries. PMID:15129597

Narita, Tetsuya; Mori, Atsushi; Hashiguchi, Hiroshi; Iizawa, Norishige; Takeda, Tomomichi; Hattori, Mikihiko; Ito, Hiromoto

2004-02-01

56

Changes in biochemical parameters after anterior cruciate ligament injury  

PubMed Central

We studied the biochemical characteristics of human knees with deficient anterior cruciate ligaments (ACL) and analysed their relationship to the time after ligamentous injury. Thirty-two patients with isolated ACL-injured knees and six healthy volunteers were enrolled. Synovial fluid samples were centrifuged after aspiration during arthroscopic examination, and aliquots of supernatant were frozen and stored at ?80°C. The samples were analysed for interleukin (IL)-1?, tumour necrosis factor (TNF)-?, IL-6, matrix metalloproteinase (MMP)-3, and tissue inhibitor of metalloproteinase (TIMP)-1 using commercially available sandwich enzyme-linked immunosorbent assay. In fluid from ACL-injured knees, the average concentrations of IL-6, MMP-3 and TIMP-1 were highly elevated in comparison with normal controls. There was a statistically significant correlation between the concentrations of MMP-3 and IL-6. The IL-6 and TIMP-1 concentrations were interrelated. The concentration of MMP-3 remained high, independent of the duration since the injury, whereas the TIMP-1 and IL-6 levels decreased. The results suggest that the timing of the treatment of an ACL-injured knee might be of importance.

Shirakura, K.; Kimura, M.; Terauchi, M.; Shinozaki, T.; Watanabe, H.; Takagishi, K.

2005-01-01

57

Anterior cruciate ligament tears in children.  

PubMed

Anterior cruciate ligament (ACL) injuries have become common in children and adolescents who practice competitive sports, accounting for 0.5-3% of all ACL injuries. Magnetic resonance imaging (MRI) is useful for diagnosis and treatment planning, but is no better than clinical examination, especially when the MRI is interpreted by less experienced health care professionals. Management of ACL deficiency in children is still controversial, but the present trend is towards early reconstruction, because repeated instability episodes may lead to secondary lesions of the knee, and induce meniscal tears and early degenerative alterations of the joint. Postoperatively, complications are rare, and most of the documented growth complications are secondary to avoidable technical errors such as placement of a fixation device across a growth plate. We recommend to reconstruct the ACL paying attention to avoid irreversible damage to the epiphyseal growth plates of the lower femur and upper tibia. PMID:22494779

Maffulli, Nicola; Del Buono, Angelo

2012-04-09

58

[Anterior cruciate ligament reconstruction: indications and techniques].  

PubMed

The anterior cruciate ligament (ACL) is a key structure for the knee joint stability and is frequently injured. Patients can be classified as "low-risk" or "high-risk" to have subsequent knee instability or meniscal injuries. This risk is based on the pre-injury level of sports participation and on the initial knee stability. For low-risk patients (mostly sedentary, senior), conservative treatment with physiotherapy leads to a satisfactory outcome. For high-risk patients (the young, competitive athlete), early ligament reconstruction is mandatory. Numerous ACL reconstruction techniques exist with auto- or allografts. However these guidelines must be adapted to the patient characteristics, motivations and expectations, in order to offer a treatment "a la carte". PMID:19160640

Duthon, Victoria B; Messerli, Guy; Menetrey, Jacques

2008-12-17

59

Anterior Cruciate Ligament Injuries in Growing Skeleton  

PubMed Central

Anterior cruciate ligament (ACL) injuries in the adult patients are thoroughly studied and published in orthopedic literature. Until recently, little was known about similar injuries in skeletally growing patients. The more frequent involvement of this age group in various athletic activities and the improved diagnostic modalities have increased the awareness and interest of ACL injuries in skeletally immature patients. ACL reconstruction in growing skeleton is controversial and carries some risks to the tibial and femoral growth plate. A guarded approach to ACL reconstruction is recommended in skeletally immature patients. Modification of activity of ACL injured young patient, proper rehabilitation and prudent planning of adolescent age ACL reconstruction carries the least risks of growth plate violation.

AlHarby, Saleh W.

2010-01-01

60

Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis?  

Microsoft Academic Search

Purpose  To determine the usefulness of magnetic resonance (MR) imaging to distinguish stable from unstable tears of the anterior cruciate\\u000a ligament (ACL) of the knee.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  MR images of 97 patients with surgically confirmed ACL tear were retrospectively reviewed. According to arthroscopic and clinical\\u000a examination, these patients had 36 stable and 61 unstable (9 partial and 52 complete) ACL tears.

Pieter Van Dyck; Jan L. Gielen; Filip M. Vanhoenacker; Kristien Wouters; Lieven Dossche; Paul M. Parizel

61

Meniscectomy and repair in the anterior cruciate ligament-deficient patient.  

PubMed

Meniscal injuries are frequently associated with acute injuries to the anterior cruciate ligament (ACL). With the passage of time, this frequency increases significantly. The management of the torn meniscus varies with the type of lesion and the patient's goals. When possible, meniscus repair combined with ACL reconstruction is recommended in young, athletically active patients. Repair may be accomplished by open or closed techniques. Because of significant risks associated with arthroscopic approaches, an outside-in type of repair has been devised. Overall, the clinical success approaches 90% if the ACL is reconstructed. Failure rates of 30% to 40% ensue if the knee remains unstable. PMID:2302896

Warren, R F

1990-03-01

62

Anterior Cruciate Ligament Reconstruction With LARS Artificial Ligament: A Multicenter Study With 3- to 5Year Follow-up  

Microsoft Academic Search

Purpose: The aim of this multicenter study was to evaluate the clinical outcome of anterior cruciate ligament (ACL) reconstruction by use of the Ligament Advanced Reinforcement System (LARS) artificial ligament (Surgical Implants and Devices, Arc-sur-Tille, France) with 3- to 5-year follow-up. Methods: From August 2004 to July 2006, 159 patients with ACL rupture underwent arthroscopic ACL recon- struction with LARS

Kai Gao; Shiyi Chen; Lide Wang; Weiguo Zhang; Yifan Kang; Qirong Dong; Haibin Zhou; Linan Li

2010-01-01

63

Outcome of Anatomic Transphyseal Anterior Cruciate Ligament Reconstruction in Tanner Stage 1 and 2 Patients With Open Physes  

Microsoft Academic Search

Background: Anterior cruciate ligament (ACL) injuries are being seen with increasing frequency in children. Treatment of the ACL-deficient knee in skeletally immature patients is controversial.Purpose: To determine the outcome of all-arthroscopic transphyseal anatomic single-bundle ACL reconstruction in Tanner stage 1 and 2 patients at a minimum of 2 years after surgery.Study Design: Case series; Level of evidence, 4.Methods: Between 2007

Catherine Hui; Justin Roe; Duncan Ferguson; Alison Waller; Lucy Salmon; Leo Pinczewski

2012-01-01

64

The dimpling phenomenon: articular cartilage injury overlying an occult osteochondral lesion at the time of anterior cruciate ligament reconstruction.  

PubMed

The authors report the arthroscopic finding of articular cartilage "dimpling" when a probe is placed onto the discrete chondral area involved over the geographic bone bruise incurred during traumatic anterior cruciate ligament disruption. As we develop an understanding of the pathology and sequelae of this osteochondral injury, this finding may be useful to document injury extent and possibly guide treatment including weight-bearing status and rehabilitation. PMID:8864012

Coen, M J; Caborn, D N; Johnson, D L

1996-08-01

65

A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears  

Microsoft Academic Search

A prospective and retrospective study was undertaken to compare the accuracy of magnetic resonance imaging (MRI) with clinical examination in diagnosing meniscal and anterior cruciate ligament (ACL) tears. Pathological findings were then confirmed during arthroscopy. One hundred fifty-four patients clinically diagnosed with a meniscal or ACL tear who ultimately had arthroscopic knee surgery were evaluated; 100 patients underwent clinical examination

Nicholas E. Rose; Stuart M. Gold

1996-01-01

66

Effects of Initial Graft Tension on Clinical Outcome After Anterior Cruciate Ligament ReconstructionAutogenous Doubled Hamstring Tendons Connected in Series with Polyester Tapes  

Microsoft Academic Search

We conducted a prospective, randomized, short-term study to clarify the effects of initial graft tension on clinical outcome after arthroscopically assisted anterior cruciate ligament reconstruction with autogenous dou bled semitendinosus and gracilis tendons connected in series with polyester tapes. Seventy Japanese patients with chronic, \\

Kazunori Yasuda; Jun Tsujino; Yoshie Tanabe; Kiyoshi Kaneda

1997-01-01

67

Radiation Exposure During Fluoroarthroscopically Assisted Anterior Cruciate Reconstruction  

Microsoft Academic Search

We prospectively evaluated the radiation exposure dur ing 50 consecutive fluoroscopically assisted anterior cruciate ligament reconstructions. Three different meth ods of anterior cruciate ligament reconstruction were performed using either rolled fascia lata allograft or bone-tendon-bone autograft. For the 50 procedures, to tal time using the fluoroscope was 119.61 minutes, or 2.38 minutes per procedure. The 16 primary fascia lata allograft

Brad J. Larson; Julie Egbert; E. Marlowe Goble

1995-01-01

68

Oblique coronal and oblique sagittal MRI for diagnosis of anterior cruciate ligament tears and evaluation of anterior cruciate ligament remnant tissue.  

PubMed

BACKGROUND: The purpose of this study was to investigate the efficacy of additional oblique magnetic resonance imaging (MRI) for the diagnosis of anterior cruciate ligament (ACL) tear and evaluation of ACL remnant tissue. METHODS: We retrospectively reviewed the records of 54 knees. Three independent readers evaluated the MR images by the use of three methods: orthogonal sagittal images only (method A); orthogonal sagittal and additional oblique sagittal images (method B); and orthogonal sagittal and oblique coronal images (method C). The sensitivity, specificity, and accuracy for the diagnosis of an ACL tear and the detection of the condition of the ACL remnant tissue by the use of each method were calculated in comparison with arthroscopic findings as the reference standard. RESULTS: The arthroscopic records revealed 27 knees with intact ACLs and 27 with torn ACLs. Among the 27 knees with torn ACLs, 9 did not have continuous remnant tissue and 18 had certain remnant tissue attached to the femur or the posterior cruciate ligament. The specificities and accuracies of methods B and C for diagnosing an ACL tear were higher than those for method A. The sensitivity, specificity, and accuracy of method C for the detection of ACL remnant tissue were higher than those for method A and B. CONCLUSIONS: Additional use of oblique MRI improved the accuracy of diagnosis of ACL tear and showed a reasonable level of efficacy in detecting ACL remnant tissue. LEVEL OF EVIDENCE: Level IV (case series). PMID:23707632

Kosaka, Masahiro; Nakase, Junsuke; Toratani, Tatsuhiro; Ohashi, Yoshinori; Kitaoka, Katsuhiko; Yamada, Hiroshi; Komura, Koji; Nakamura, Shinji; Tsuchiya, Hiroyuki

2013-05-23

69

Associação entre tempo de ruptura do ligamento cruzado anterior e freqüência de outras lesões articulares do joelho * Association between the time of ruptured anterior cruciate ligament and the frequency of other knee joint lesions  

Microsoft Academic Search

Objective: To assess whether the time of anterior cruciate ligament (ACL) rupture correlates with the frequency of associated lesions to other knee structures. Methods: A retrospective study from 46 patients, ages ranging from 16 to 43 years (44 male and two female patients) with ACL lesions was performed. All patients had arthroscopic confirmation of their lesions, which were recorded in

Silva RR; Matos MA; Silva DJA; ROBSON ROCHA DA SILVA; MARCOS ALMEIDA MATOS; DANIEL JOSÉ DE ARAÚJO; MARCONDES DA SILVA ABREU

70

Arthroscopic reinforced capsular shift of anterior shoulder instability  

Microsoft Academic Search

This article presents an arthroscopic inferior capsular shift technique. In this technique, the same type of inferior capsular shift as with the open standard Neer procedure can be performed. After standard diagnostic shoulder arthroscopy, a bone trough is made along the capsular attachment to the humeral head using an abrader. An inverted L-shaped incision is performed in the anterior capsule.

Basim A Fleega

2004-01-01

71

Anterior cruciate ligament graft impingement against the posterior cruciate ligament: diagnosis using MRI plus three-dimensional reconstruction software  

Microsoft Academic Search

ObjectiveThe purpose of this study was to evaluate anterior cruciate ligament (ACL) impingement against the posterior cruciate ligament (PCL) with the knee in an extended position, which arthroscopy cannot detect.

Eisaku Fujimoto; Yoshio Sumen; Masataka Deie; Masanori Yasumoto; Kenji Kobayashi; Mitsuo Ochi

2004-01-01

72

Anterior cruciate ligament surgery in the rabbit  

PubMed Central

Background Various methods regarding allograft knee replacements have been described. The animal models, which are generally used for this purpose include sheep, dogs, goats, and pigs, and accrue significant costs for study protocols. The authors herein describe an efficient and cost-effective model to study either native or tissue-engineered allografts for anterior cruciate ligament (ACL) replacement in a New Zealand rabbit model with the potential for transgenic and cell migration studies. Methods ACL reconstructions were performed in rabbits under general anesthesia. For fresh allograft implantations, two animals were operated in parallel. Each right extensor digitorum longus tendon was harvested and prepared for implantation. After excision of the ACL, tibial and femoral bone tunnels were created to implant each graft in the native ACL position. Results During a 2-year period, the authors have successfully undertaken this surgery in 61 rabbits and have not noticed any major complications attributed to this surgical technique. In addition, the authors have observed fast recovery in the animals postoperatively. Conclusion The authors recommend this surgical procedure as an excellent model for the study of knee surgery.

2013-01-01

73

Joint hypermobility and anterior cruciate ligament injury.  

PubMed

PURPOSE. To compare the rates of joint hypermobility in patients with and without anterior cruciate ligament (ACL) injury. METHODS. Records of 135 men and 75 women (mean age, 24.6 years) who underwent ACL reconstructions were reviewed and compared with 55 male and 35 female controls with no knee injury. Joint hypermobility was evaluated by 2 examiners using the Beighton score. The maximum score was 9, and a score of 4 or greater was defined as hypermobility. RESULTS. The mean time from injury to presentation was 18 days. A non-contact mechanism of injury was more common. The inter-observer reliability was 0.7. 127 (60.5%) of the patients with ACL injury and 23 (25.5%) of the controls had hypermobility (p<0.01). Among them, 58% and 24% were men and 65% and 29% were women, respectively. Female gender was associated with hypermobility. Patients with ACL injury were more likely to have joint hypermobility with an odds ratio of 4.46. CONCLUSION. Joint hypermobility was more common in patients with ACL injury. PMID:24014780

Vaishya, R; Hasija, R

2013-08-01

74

Resorbable screws versus pins for optimal transplant fixation (SPOT) in anterior cruciate ligament replacement with autologous hamstring grafts: rationale and design of a randomized, controlled, patient and investigator blinded trial [ISRCTN17384369  

Microsoft Academic Search

BACKGROUND: Ruptures of the anterior cruciate ligament (ACL) are common injuries to the knee joint. Arthroscopic ACL replacement by autologous tendon grafts has established itself as a standard of care. Data from both experimental and observational studies suggest that surgical reconstruction does not fully restore knee stability. Persisting anterior laxity may lead to recurrent episodes of giving-way and cartilage damage.

Dirk Stengel; Gerrit Matthes; Julia Seifert; Volker Tober; Sven Mutze; Grit Rademacher; Axel Ekkernkamp; Kai Bauwens; Michael Wich; Dirk Casper

2005-01-01

75

Rehabilitation After Anterior Cruciate Ligament Reconstruction  

PubMed Central

Background: Rigorous rehabilitation after anterior cruciate ligament (ACL) reconstruction is necessary for a successful surgical outcome. A large number of clinical trials continue to assess aspects of this rehabilitation process. Prior systematic reviews evaluated fifty-four Level-I and II clinical trials published through 2005. Methods: Eighty-five articles from 2006 to 2010 were identified utilizing multiple search engines. Twenty-nine Level-I or II studies met inclusion criteria and were evaluated with use of the CONSORT (Consolidated Standards of Reporting Trials) criteria. Topics included in this review are postoperative bracing, accelerated strengthening, home-based rehabilitation, proprioception and neuromuscular training, and six miscellaneous topics investigated in single trials. Results: Bracing following ACL reconstruction remains neither necessary nor beneficial and adds to the cost of the procedure. Early return to sports needs further research. Home-based rehabilitation can be successful. Although neuromuscular interventions are not likely to be harmful to patients, they are also not likely to yield large improvements in outcomes or help patients return to sports faster. Thus, they should not be performed to the exclusion of strengthening and range-of-motion exercises. Vibration training may lead to faster and more complete proprioceptive recovery but further evidence is needed. Conclusions: Several new modalities for rehabilitation after ACL reconstruction may be helpful but should not be performed to the exclusion of range-of-motion, strengthening, and functional exercises. Accelerated rehabilitation does not appear to be harmful but further investigation of rehabilitation timing is warranted. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Kruse, L.M.; Gray, B.; Wright, R.W.

2012-01-01

76

Prevention of anterior cruciate ligament injuries.  

PubMed

Numerous studies have found that female athletes who participate in jumping and pivoting sports are four to six times more likely to sustain a knee ligament injury, such as anterior cruciate ligament (ACL) injury, than male athletes participating in the same sports [1-8]. A widening gender gap in the number of serious knee ligament injuries exists due to geometric growth in female athletic participation, coupled with the four- to sixfold higher injury rate. More than 50,000 serious knee injuries are projected to occur in female varsity intercollegiate and high school athletics each year [9, 10]. Most ACL injuries occur by noncontact mechanisms, often during landing from a jump or making a lateral pivot while running [2, 11]. Knee instability, due to ligament dominance (decreased medial-lateral neuromuscular control of the joint), quadriceps dominance (increased quadriceps recruitment and decreased hamstring recruitment and strength), and leg dominance (side-to-side differences in strength, flexibility, and coordination) are possible contributing factors to the increased incidence of knee injury in female athletes [5, 6]. In this review, dynamic neuromuscular analysis (DNA) training is defined, and a rationale is presented for correcting the neuromuscular imbalances that may result in dynamic knee instability during sports play. Dynamic neuromuscular training has been shown to increase knee stability and decrease knee injury rates in female athletes [5, 12.., 13.]. Preliminary research on athlete screening and injury prediction based on the three aforementioned imbalances also is presented with recommendations for developing screening protocols for the identification of high-risk athletes. PMID:12112973

Hewett, T E; Myer, G D; Ford, K R

2001-12-01

77

Anterior Cruciate Ligament Injuries in Wakeboarding  

PubMed Central

Background: Wakeboarding is an increasingly popular sport that involves aggressive stunts with high risk for lower extremity injury, including anterior cruciate ligament (ACL) rupture. Little has been reported on prevalence or mechanism of ACL injury while wakeboarding. Hypothesis: The prevalence of ACL injury in wakeboarding approaches that of other high-risk sports. Analyzing the mechanism of ACL injury may aid in future efforts of prevention. Study Design: Descriptive epidemiology study. Methods: In sum, 1580 surveys were sent internationally to professional and amateur wakeboarders. The survey questioned the participants on their history of an ACL tear while wakeboarding and asked them to describe the mechanism of injury and treatment. Results: A total of 123 surveys were returned. Of this group, 52 (42.3%) acknowledged having had an ACL tear while wakeboarding. The majority described feeling a pop or buckle after attempting to land a high jump. Only 5 participants (13.5%) described a rotational mechanism created by catching the board edge in the water. Thirty-seven participants (71.15%) said that the injury ruined their ability to wakeboard before reconstruction, and 41 (78.85%) had the injury repaired surgically. Conclusion: The prevalence of ACL tears in this data set, 42.3%, is the highest reported in the literature for wakeboarding and one of the highest for any sport. The main mechanism of injury appears to involve axial compression while one lands in a provocative position; it is not related to a rotational force created by fixed bindings. The injury should be surgically repaired to effectively continue the sport. Further study is needed to determine if wakeboarding represents a high-risk sport for ACL injury. Clinical Significance: Wakeboarding may be a high-risk sport for ACL injury. Noncontact axial compression appears to be the main mechanism of injury.

Starr, Harlan M.; Sanders, Brett

2012-01-01

78

The Anterior Cruciate Ligament Tear Rate Varies by Race in Professional Women's Basketball  

Microsoft Academic Search

Background: Female basketball players are more likely to tear their anterior cruciate ligament than are their male counterparts. Many causes are postulated for the difference observed in the rate of anterior cruciate ligament tears between genders. However, little is known about the differences in tears within gender.Hypothesis: The rate of anterior cruciate ligament tears is different in White European American

Thomas H. Trojian; Seamus Collins

2006-01-01

79

CT Arthrography and Virtual Arthroscopy in the Diagnosis of the Anterior Cruciate Ligament and Meniscal Abnormalities of the Knee Joint  

PubMed Central

Objective To determine the diagnostic accuracy of CT arthrography and virtual arthroscopy in the diagnosis of anterior cruciate ligament and meniscus pathology. Materials and Methods Thirty-eight consecutive patients who underwent CT arthrography and arthroscopy of the knee were included in this study. The ages of the patients ranged from 19 to 52 years and all of the patients were male. Sagittal, coronal, transverse and oblique coronal multiplanar reconstruction images were reformatted from CT arthrography. Virtual arthroscopy was performed from 6 standard views using a volume rendering technique. Three radiologists analyzed the MPR images and two orthopedic surgeons analyzed the virtual arthroscopic images. Results The sensitivity and specificity of CT arthrography for the diagnosis of anterior cruciate ligament abnormalities were 87.5%-100% and 93.3-96.7%, respectively, and those for meniscus abnormalities were 91.7%-100% and 98.1%, respectively. The sensitivity and specificity of virtual arthroscopy for the diagnosis of anterior cruciate ligament abnormalities were 87.5% and 83.3-90%, respectively, and those for meniscus abnormalities were 83.3%-87.5% and 96.1-98.1%, respectively. Conclusion CT arthrography and virtual arthroscopy showed good diagnostic accuracy for anterior cruciate ligament and meniscal abnormalities.

Lee, Whal; Kim, Ho Sung; Kim, Seok Jung; Kim, Hyung Ho; Chung, Jin Wook; Kang, Heung Sik; Choi, Ja-Young

2004-01-01

80

Isolated Type II Superior Labral Anterior Posterior LesionsAge-Related Outcome of Arthroscopic Fixation  

Microsoft Academic Search

Background: Superior labral anterior posterior tears have been described as symptomatic lesions in shoulders of patients of varying ages. It is unknown if age affects clinical outcome of arthroscopic fixation of type II superior labral anterior posterior repairs.Hypothesis: Clinical outcome of arthroscopic fixation of isolated type II superior labral anterior posterior tears differs between younger (<40 years) and older (?40

Brian R. Neri; Emily A. Vollmer; Ronald S. Kvitne

2009-01-01

81

A symptomatic cyclops lesion 4 years after anterior cruciate ligament reconstruction.  

PubMed

The cyclops lesion is a fibrous nodule with central granulation tissue located anterolateral to the tibial tunnel after intra-articular reconstruction of the anterior cruciate ligament (ACL) that has been shown to be a cause of failure to regain full extension in the early postoperative period. We present the case of a 23-year-old woman who had undergone arthroscopic ACL reconstruction with a patellar tendon autograft 4 years prior to presentation. Following her reconstruction, she regained full range of motion and returned to collegiate cheerleading. At presentation, she complained of a gradual loss of full extension and joint-line pain with terminal extension. On examination, her graft was stable and she lacked 3 degrees of extension. Magnetic resonance imaging documented a 1-cm mass of low signal intensity immediately anterior to the ACL graft within the intercondylar notch. At arthroscopy, a large amount of thick, immobile scar tissue was found immediately anterior to the ACL, consistent with a cyclops lesion. The lesion was debrided and the patient did well postoperatively. Patients who present with delayed-onset loss of extension after ACL reconstruction should undergo careful evaluation including radiographs and magnetic resonance imaging. If a cyclops lesion is diagnosed, arthroscopic resection should be undertaken. PMID:11172260

Nuccion, S L; Hame, S L

2001-02-01

82

Silk matrix for tissue engineered anterior cruciate ligaments  

Microsoft Academic Search

A silk-fiber matrix was studied as a suitable material for tissue engineering anterior cruciate ligaments (ACL). The matrix was successfully designed to match the complex and demanding mechanical requirements of a native human ACL, including adequate fatigue performance. This protein matrix supported the attachment, expansion and differentiation of adult human progenitor bone marrow stromal cells based on scanning electron microscopy,

Gregory H Altman; Rebecca L Horan; Helen H Lu; Jodie Moreau; Ivan Martin; John C Richmond; David L Kaplan

2002-01-01

83

Silk matrix for tissue engineered anterior cruciate ligaments  

Microsoft Academic Search

A silk-fiber matrix was studied as a suitable material for tissue engineering anterior cruciate ligaments (ACL). The matrix was successfully designed to match the complex and demanding mechanical requirements of a native human ACL, including adequate fatigue performance. This protein matrix supported the attachment, expansion and differentiation of adult human progenitor bone marrow stromal cells based on scanning electron microscopy,

Gregory H. Altman; Rebecca L. Horana; Helen H. Lu; Jodie Moreau; John C. Richmond; David L. Kaplan

84

MMPs and TIMPs Expression and the Anterior Cruciate Ligament Repair  

Microsoft Academic Search

Human anterior cruciate ligament (ACL) has poor healing ability after injury. Inflammation and accumulation of matrix metalloproteinases (MMPs) in synovial fluids may be involved in the process. Tissue inhibitor metalloproteinases (TIMPs) may be independent of MMPs inhibition. A rat ACL rotating injury apparatus was designed to mimic ACL injury. ACL showed the higher MMP-l\\/TIMP-1 ratio after injury. Our recently findings

Ruyue Xue; Li Yang; Zhenyu Tang; Jin Zhang; Yequan Wang; K. Sung

2009-01-01

85

IMMEDIATE STRENGTH AFTER SUTURE OF A TORN ANTERIOR CRUCIATE LIGAMENT  

Microsoft Academic Search

In an animal model we determined the strength of anterior cruciate ligaments (ACL) after section and repair by four different methods and compared it with that of the intact ligament. The standard suturing technique of multiple loops through the ligament stumps was used. Stronger suture material did not give a stronger repair. Wrapping a fine polyester mesh around the ligament

W. J. P. RADFORD; A. A. AMIS; F. W. HEATLEY

86

Knee rehabilitation after anterior cruciate ligament reconstruction and repair  

Microsoft Academic Search

The purpose of this paper is to present the specifics and rationale of our postoperative rehabilitation pro gram after anterior cruciate ligament (ACL) recon struction and compare it with an international survey of 50 knee experts. It is important to stress that what we present is opinion. This opinion, however, is based on principles, guidelines, and specifics which we be

Lonnie Paulos; Frank R. Noyes; Edward Grood; David L. Butler

1981-01-01

87

SPECT Bone Scintigraphy of Anterior Cruciate Ligament Injury  

Microsoft Academic Search

This retrospective analysis of SPECT bone scans of the knee was undertaken to define typical bone scan appearances and to assess the sensitivity of this method. We looked at 14 patients, mostly with chronic knee pain, who had anterior cruciate ligament (ACL) tears detected by MRI. Method: Of the 14 patients, 10 were referred for bone scanning following injury and

Gary J. R. Cook; Paul J. Ryan; Susan E. M. Clarke; Ignac Fogelman

88

Anterior cruciate ligament suture in comparison with plasty  

Microsoft Academic Search

In this retrospective study we analyse the results of primary anterior cruciate ligament (ACL) sutures, primary ACL plastics and secondary ACL plastics 5 years after operation. All operations were performed with an additional PDS augmentation. Follow-ups of 100 of 130 patients could be done (80 male and 20 female). The average age at time of operation was 29.2 years. ACL

D. Träger; K. Pohle; W. Tschirner

1995-01-01

89

Compression or distraction of the anterior cruciate injured knee  

Microsoft Academic Search

100 consecutive patients with a recent anterior cruciate ligament injury were examined with respect to type of sports activity that caused the injury, mechanism of injury and the occurrence of collateral ligament and meniscal lesions. There were 53 medial collateral ligament injuries, 12 medial, 35 lateral and 11 bicompartmental meniscal lesions. 59 patients were injured during contact sports, 30 in

T. Friden; T. Erlandsson; R. Zätterström; A. Lindstrand; U. Moritz

1995-01-01

90

Management of Sports-Related Anterior Cruciate Ligament Injuries  

Microsoft Academic Search

Injuries from recreational and competitive sports activities have increased significantly during the past two decades. The anterior cruciate ligament (ACL) is one of the most commonly injured knee ligament in athletes. As the ACL is the knee's primary intra-articular stabilizer, injuries to this ligament can seriously alter athletes' physical activity levels or end their sports careers. The medical and surgical

Laura Clasby; Mary Ann Young

1997-01-01

91

Meniscus repair rehabilitation with concurrent anterior cruciate reconstruction  

Microsoft Academic Search

Meniscal repair is preferable to meniscectomy because of the recognized benefits of the meniscus and the consequences of its loss. The most appropriate rehabilitation program after meniscus repair is unclear. Many meniscus repairs occur in association with anterior cruciate ligament (ACL) reconstructions. An accelerated program permitting early full weight bearing, unrestricted motion, and no limitations on pivoting sports after the

F. Alan Barber; Sarah D. Click

1997-01-01

92

Spontaneous rupture of the anterior cruciate ligament after anabolic steroids  

Microsoft Academic Search

Anabolic steroids remain popular among body builders and power athletes despite numerous warning about their side effects. A case of spontaneous rupture of the anterior cruciate ligament is reported in a bodybuilder taking steroids. While there are many published reports of tendon rupture associated with steroid intake, the authors could find no report relating to ligament disruption.

B J Freeman; G D Rooker

1995-01-01

93

Spontaneous rupture of the anterior cruciate ligament after anabolic steroids.  

PubMed

Anabolic steroids remain popular among body builders and power athletes despite numerous warning about their side effects. A case of spontaneous rupture of the anterior cruciate ligament is reported in a bodybuilder taking steroids. While there are many published reports of tendon rupture associated with steroid intake, the authors could find no report relating to ligament disruption. PMID:8808545

Freeman, B J; Rooker, G D

1995-12-01

94

Timing of surgery in anterior cruciate ligament-injured knees  

Microsoft Academic Search

Despite recent advances in the surgical techniques of anterior cruciate ligament (ACL) reconstruction in the past two decades, there is no consensus of opinion as to the ideal timing for ACL surgery. Based on the evolution of management of patients with ACL injuries over the period 1982–1994, we have found that various factors need to be considered in order to

K. D. Shelbourne; D. V. Patel

1995-01-01

95

The biomechanics of anterior cruciate ligament rehabilitation and reconstruction  

Microsoft Academic Search

The rehabilitation of knee injuries involving the anterior cruciate ligament (ACL) is controversial. This paper describes strain in the normal and reconstructed ACL during a series of passive and active tests of knee flexion with and without varus, valgus, and axial rotation torques on the tibia. Strain in the human knee ACL was significantly different depending on whether the knee

Steven W. Arms; Malcolm H. Pope; Robert J. Johnson; Richard A. Fischer; Inga Arvidsson; Ejnar Eriksson

1984-01-01

96

Criterion-based rehabilitation program after anterior cruciate ligament reconstruction  

Microsoft Academic Search

Traditional rehabilitation protocols consist of a progression of exercises and functional activities based on timeframes that serve as strict guidelines for physical therapists and athletic trainers. Patients who have undergone reconstruction of the anterior cruciate ligament are guided through the process via written schedule which often overlooks their ability to master basic functional activities, such as walking. Basic science and

Elizabeth A. Eckersley; Julie M. Fritz; James J. Irrgang

1995-01-01

97

Computer Assisted Knee Anterior Cruciate Ligament Reconstruction: First Clinical Tests  

Microsoft Academic Search

Anterior Cruciate Ligament reconstruction is a delicate task. An anisometric position of the graft often leads to failure. We propose an original method that allows to position the central part of the ligament graft at the least anisometric sites avoiding an impingement with the femoral notch's roof. The system uses a workstation and a 3D optical localizer. This technique has

Vincent Dessenne; Stéphane Lavallée; Rémi Julliard; Philippe Cinquin; Rachel Orti

1995-01-01

98

Behavior of sutures used in anterior cruciate ligament reconstructive surgery  

Microsoft Academic Search

This study was performed to determine the material properties of sutures commonly used in orthopedic surgery in order to allow selection of the most appropriate one for securing a hamstring or quadriceps tendon graft in anterior cruciate ligament (ACL) reconstruction. Three suture materials (number 5 Ticron, number 5 Ethibond, and 5 mm Mersilene tape) were tested. The ultimate tensile load

E. E. Spencer; H. R. Chissell; J. T. Spang; J. A. Feagin Jr

1996-01-01

99

Success of Meniscal Repair at Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Background: Meniscal repair is performed in an attempt to prevent posttraumatic arthritis resulting from meniscal dysfunction after meniscal tears. The socioeconomic implications of premature arthritis are significant in the young patient population. Investigations and techniques focusing on meniscus preservation and healing are now at the forefront of orthopaedic sports medicine.Hypothesis: Concomitant meniscal repair with anterior cruciate ligament reconstruction is a

Charles V. Toman; Warren R. Dunn; Kurt P. Spindler; Annunziata Amendola; Jack T. Andrish; John A. Bergfeld; David Flanigan; Morgan H. Jones; Christopher C. Kaeding; Robert G. Marx; Matthew J. Matava; Eric C. McCarty; Richard D. Parker; Michelle Wolcott; Armando Vidal; Brian R. Wolf; Laura J. Huston; Frank E. Harrell; Rick W. Wright

2009-01-01

100

Anterior Cruciate Ligament—Injured Subjects Have Smaller Anterior Cruciate Ligaments Than Matched ControlsA Magnetic Resonance Imaging Study  

Microsoft Academic Search

Background: Very few studies examining the predisposing anatomical factors leading to anterior cruciate ligament (ACL) injuries have examined the ACL itself, and none of these directly examined the difference in ACL properties between injured and matched control subjects.Hypothesis: The ACL total volume in people who have experienced a noncontact ACL injury is smaller than that of matched controls.Study Design: Case

Ajit M. W. Chaudhari; Eric A. Zelman; David C. Flanigan; Christopher C. Kaeding; Haikady N. Nagaraja

2009-01-01

101

Simultaneous Rupture of the Patellar Tendon and the Anterior Cruciate Ligament: Report of Three Cases.  

PubMed

This study describes three cases of simultaneous ruptures of the patellar tendon (PT) and the anterior cruciate ligament (ACL). The treatment and the pathogenesis of this rare lesion are discussed. All three cases demonstrated lesions of all structures at the medial compartment. Unlike other reported cases, where an eccentric contraction of the quadriceps was present, the patients of the present study had sustained a forceful valgus injury with external rotation. We detected no displacements of the patella in any patients. All cases underwent a staged surgical procedure. Repair of the PT and of medial peripheral structures was performed immediately after injury; then, once the patients regained a full range of motion (ROM), they underwent an arthroscopic reconstruction of the ACL with ipsilateral hamstrings. At the follow-up stage, all cases showed a stable knee without restricted ROM. PMID:23288778

Mariani, Pier Paolo; Cerullo, Guglielmo; Iannella, Germano

2012-05-01

102

Anterior cruciate ligament recostruction with bone-patellar tendon-bone autograft in Tanner 3 stage patients with open physes.  

PubMed

Ten skeletally immature patients were treated with an arthroscopic-assisted anterior cruciate ligament reconstruction with bone-patellar tendon bone autograft (compass, 50-55°; holes, 7-9 mm). Radiological assessments (standard radiograph), Orthopädische Arbeitsgruppe Knie (OAK) score and KT 1000, were conducted on all patients, 1 year after surgery. Skeletal maturity had been reached by all patients and no complications were observed. All patients returned to their preinjury sport level. Drilling more vertical tunnels when bone-tendon-bone autograft was chosen to avoid partial epiphysiodesis and offers good functional and isometric results. PMID:21886009

Memeo, Antonio; Pedretti, Leopoldo; Miola, Francesca; Albisetti, Walter

2012-09-01

103

Extensor tendons and deep peroneal nerve adhesion: Treated by complete anterior ankle arthroscopic capsulotomy  

Microsoft Academic Search

Ankle arthroscopy has been increasingly applied to the diagnostic and therapeutic treatment of ankle disorders. A case of adhesion of the extensor tendons and deep peroneal nerve to the anterior ankle capsule after multiple arthroscopic procedures of the ankle was reported. He was successfully treated by complete anterior ankle arthroscopic capsulotomy.

T. H. Lui

104

Navigated anterior cruciate ligament reconstruction: radiographic validation of a nonimage-based system.  

PubMed

The authors compared the intraoperative navigated measurements of the location of the tibial and femoral tunnels during arthroscopic-assisted anterior cruciate ligament reconstruction to the postoperative measurements performed on standard plain radiographs in 56 patients. The position of the center of the tibial and femoral tunnels was measured intraoperatively with the OrthoPilot (B. Braun Aesculap, Tuttlingen, Germany) and postoperatively on plain anteroposterior and lateral radiographs. The center of the tibial tunnel was located at 43% of the mediolateral tibial dimension intraoperatively and at 41% of the mediolateral tibial dimension postoperatively (P=.14). The center of the tibial tunnel tibial was located at 40% of the anteroposterior tibial dimension intraoperatively and at 35% of the anteroposterior tibial dimension postoperatively (P=.01). The center of the femoral tunnel was located at 85% of the anteroposterior femoral dimension intraoperatively and at 76% of the anteroposterior femoral dimension postoperatively (P<.001). A significant correlation was found between intraoperative navigated and postoperative radiographic measurements only at the femur. Good agreement existed between all navigated and radiographic measurements. The OrthoPilot navigation system allows an accurate measurement of the location of the tibial and femoral tunnels during anterior cruciate ligament reconstruction. PMID:23026247

Jenny, Jean-Yves; Abane, Lamine

2012-10-01

105

Ligamentous injuries of the knee: anterior cruciate, medial collateral, posterior cruciate, and posterolateral corner injuries.  

PubMed

This article discusses athletic injuries of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and posterolateral corner. Best evidence to date validates that conservative management of ACL ruptures is a reasonable strategy. Current data also seem to advocate nonoperative management of PCL injuries. All isolated MCL injuries, regardless of grade, are usually treated with a brief period of immobilization and symptomatic management. Although the surgical literature often advocates surgical treatment of posterolateral corner injuries, there have been no randomized trials substantiating that these injuries are best treated surgically. PMID:23668648

Morelli, Vincent; Bright, Crystal; Fields, Ashley

2013-03-14

106

A prospective comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction in female patients  

Microsoft Academic Search

The aim of the study is to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third, bone-patellar tendon-bone (BTB group) (n=28) and four-strand semitendinosus\\/gracilis (ST\\/G group) (n=31) autografts in female patients. The type of study was non-randomised prospective consecutive series. A consecutive series of 61 female patients, all with unilateral ACL ruptures, was included in the study.

Michael Svensson; Ninni Sernert; Lars Ejerhed; Jon Karlsson; Jüri T. Kartus

2006-01-01

107

A prospective comparison of bone-patellar tendon-bone and hamstring tendon grafts for anterior cruciate ligament reconstruction in male patients  

Microsoft Academic Search

The aim of the study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third,\\u000a bone-patellar tendon-bone (BPTB Group) (n = 45) and four-strand semitendinosus\\/gracilis (ST\\/G Group) (n = 78) autografts in male patients. The type of study is non-randomised, prospective consecutive series. A consecutive series\\u000a of 126 male patients, all with unilateral ACL ruptures, was included in the study.

Gauti Laxdal; Ninni Sernert; Lars Ejerhed; Jon Karlsson; Jüri T. Kartus

2007-01-01

108

Analysis of subjective, objective and functional examination tests after anterior cruciate ligament reconstructionA follow-up of 527 patients  

Microsoft Academic Search

This study included 527 patients (178 female and 349 male) with unilateral anterior cruciate ligament (ACL) rupture who\\u000a underwent arthroscopic ACL reconstruction using bone-patellar tendon-bone autograft and interference screw fixation. The follow-up\\u000a examination was performed by independent observers at a median of 38 (21–68) months after the index operation. At the follow-up,\\u000a the Lysholm score was 86 (14–100) points, the

Ninni Sernert; Jüri Kartus; Kristina Köhler; Sven Stener; Janeth Larsson; Bengt I. Eriksson; Jon Karlsson

1999-01-01

109

Instrumented measurement of anterior-posterior translation in knees with chronic anterior cruciate ligament tear  

Microsoft Academic Search

Anteroposterior translation of the knee joint was measured with a Knee Signature System device on 12 women and 14 men with a unilateral, chronic, isolated, anterior cruciate ligament (ACL) tear. A control group with stable knees consisted of 10 women and 10 men. Anterior translation at 178 N load of the uninjured knees was 8.0 mm (± 2.2 mm) and

T. Mononen; H. Alaranta; A. Harilainen; J. Sandelin; I. Vanhanen; K. Österman

1997-01-01

110

Magnetic Resonance Imaging, Scintigraphy, and Arthroscopic Evaluation of Traumatic Hemarthrosis of the Knee  

Microsoft Academic Search

Forty patients with traumatic knee hemarthrosis were examined within 1 week after injury and observations made with magnetic resonance imaging, scintigraphy, arthroscopic evaluation, radiography, and physical ex amination were compared. Thirty-four patients (85%) had anterior cruciate ligament injuries according to the arthroscopic findings and 28 (83%) of these had asso ciated meniscal tears. Magnetic resonance imaging confirmed the arthroscopic findings,

Torsten Adalberth; Harald Roos; Marten Laurén; Per Åkeson; Maja Sloth; Kjell Jonsson; Anders Lindstrand; L. Stefan Lohmander

1997-01-01

111

Current recommendations for anterior cruciate ligament bracing: when to use.  

PubMed

Braces are often used during various stages of recovery from an anterior cruciate ligament tear despite there being sparse definitive research supporting their use. This article reviews the literature on brace use for patients with anterior cruciate ligament tears in order to provide a guide for clinicians. There is evidence to support immediate postoperative bracing, with the goals of maintaining full extension and decreasing effusion. There may be a psychological benefit for its use in return to sport; however, this should be weighed against decreased performance. In the context of modern graft-fixation techniques and early mobilization protocols, empiric functional brace prescription is not required for successful long-term clinical outcomes and return to sport. PMID:23445858

Masini, Brendan D; Owens, Brett D

2013-02-01

112

Anterior cruciate ligament allograft transplantation for intraarticular ligamentous reconstruction  

Microsoft Academic Search

A multiplicity of surgical operations have been developed in an attempt to achieve satisfactory function after anterior cruciate ligament (ACL) repair. None of these procedures have been able to reproduce the fiber organization anatomy of attachment site, vascularity, or function of the ACL. Twenty-nine foxhounds received a deep-frozen bone-ACL-bone allograft and a ligament augmentation device (LAD). Biomechanical, microvascular, and histological

M. Goertzen; A. Dellmann; J. Gruber; H. Clahsen; K. F. Biirrig

1992-01-01

113

Neurohistological findings after experimental anterior cruciate ligament allograft transplantation  

Microsoft Academic Search

A multiplicity of surgical operations have been developed in an attempt to achieve satisfactory function after anterior cruciate ligament (ACL) repair. None of these procedures have been able to duplicate the fiber organization, anatomy of the attachment site, vascularity, or function of the ACL. Eighteen foxhounds received a deep-frozen bone-ACL-bone allograft and a ligament augmentation device. Neurohistological changes were evaluated

M. Goertzen; J. Gruber; A. Dellmann; H. Clahsen; K.-P. Schulitz

1992-01-01

114

Accuracy of MRI patterns in evaluating anterior cruciate ligament tears  

Microsoft Academic Search

The purpose of this study was to determine the different patterns of anterior cruciate ligament (ACL) tears on MRI and the\\u000a prevalence and accuracy of these patterns. Images were obtained on high-tesla and low-tesla units and the results compared\\u000a to determine whether field strength affects the interpretation using the grading system. In 172 patients who underwent knee\\u000a MRI (109 knees

Kevin P. Barry; Mamed Mesgarzadeh; Joseph Triolo; Ray Moyer; Jamshid Tehranzadeh; Akbar Bonakdarpour

1996-01-01

115

“Biological failure” of the anterior cruciate ligament graft  

Microsoft Academic Search

Anterior cruciate ligament (ACL) reconstruction has the best chance for success when the graft undergoes extensive biologic\\u000a remodeling and incorporation after implantation. There are many factors that can lead to graft failure and possible revision\\u000a surgery. These include patient selection; surgical technique such as graft placement and tensioning; the use of allograft\\u000a versus autograft; mechanical factors such as secondary restraint

J. Ménétrey; V. B. Duthon; T. Laumonier; D. Fritschy

2008-01-01

116

Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Revision Surgery  

Microsoft Academic Search

With the increasing number of double-bundle anterior cruciate ligament (ACL) reconstructions being performed, revision cases are expected. This report describes the first 3 cases of revision double-bundle ACL surgeries performed at our institution. In 3 athletes in whom the ACL was previously reconstructed with an anatomic double-bundle technique, new traumatic events occurred and an ACL retear was diagnosed. In cases

Rodrigo Kaz; James S. Starman; Freddie H. Fu

2007-01-01

117

Transitioning to anatomic anterior cruciate ligament graft placement.  

PubMed

Anterior cruciate ligament (ACL) reconstruction techniques continue to improve. Recent biomechanical studies have found improved rotational stability as femoral tunnel placement becomes more horizontal and closer to the true ACL footprint. Clinical studies also correlate improved outcomes with these more anatomic reconstructions. This article reviews the transition from traditional to anatomic ACL reconstructions, as well as 3 techniques for achieving this: the modified transtibial technique, use of an accessory medial portal, and the retrograde drilling technique. PMID:19476183

Sohn, David H; Garrett, William E

2009-04-01

118

Simultaneous bilateral anterior cruciate ligament reconstruction: a safe option  

Microsoft Academic Search

When patients present with bilateral anterior cruciate ligament (ACL) deficiency and require reconstruction in both knees,\\u000a a single setting or staged approach can be adopted. Although single-setting reconstruction has been described, there are no\\u000a published case series that describe simultaneous bilateral ACL reconstruction. We report a case series of eight patients who\\u000a underwent simultaneous bilateral ACL reconstruction. We used two-camera

Adnan Saithna; Jamie Arbuthnot; Richard Carey-Smith; Tim Spalding

2010-01-01

119

Hip Acetabular Dysplasia and Joint Laxity of Female Anterior Cruciate Ligament—Injured Patients  

Microsoft Academic Search

Background: It has been noted that some female anterior cruciate ligament—injured patients have complaints of both coxalgia and joint laxity.Hypothesis: Female anterior cruciate ligament—injured patients tend to have both acetabular dysplasia and generalized joint laxity.Study Design: Cohort study (prevalence); Level of evidence, 2.Methods: Hip radiographs of 100 female anterior cruciate ligament—injured patients and 40 female athletes without any hip joint

Junya Yamazaki; Takeshi Muneta; Young-Jin Ju; Toshiyuki Morito; Toru Okuwaki; Ichiro Sekiya

2011-01-01

120

Revision Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft5-to 9Year Follow-up  

Microsoft Academic Search

Background: The results of revision anterior cruciate ligament reconstruction are limited in the current literature, and no studies have previously documented the outcome of revision anterior cruciate ligament reconstruction using solely hamstring tendon grafts.Hypothesis: Revision anterior cruciate ligament reconstruction with 4-strand hamstring tendon graft affords acceptable results and is comparable to reported outcomes with the bone–patellar tendon–bone graft.Study Design: Case

Lucy J. Salmon; Leo A. Pinczewski; Vivianne J. Russell; Kathryn Refshauge

2006-01-01

121

Natural history of anterior cruciate tears  

Microsoft Academic Search

An evaluation of 361 patients with documented anterior cru ciate tears was carried out with analysis of mechanisms, symp tomatology, physical findings, and limitations. At the time of injury, patients generally heard a loud pop and felt their knee \\

James A. Arnold; Tom P. Coker; Lynn M. Heaton; John P. Park; Walter Duke Harris

1979-01-01

122

Outcomes of Revision Arthroscopic Type II Superior Labral Anterior Posterior Repairs  

Microsoft Academic Search

Background: Outcomes of arthroscopic type II superior labral anterior posterior (SLAP) repairs have been reported with success. However, published data regarding outcomes of revision arthroscopic type II SLAP repairs are lacking.Hypothesis: Outcomes of revision arthroscopic type II SLAP repairs are inferior to those of primary repairs.Study Design: Case series; Level of evidence, 4.Methods: A retrospective chart review was performed to

Ronald E. Glousman

2011-01-01

123

Biomechanical Comparison of Single-Tunnel-Double-Bundle and Single-Bundle Anterior Cruciate Ligament Reconstructions  

PubMed Central

Background Anatomic double-bundle reconstruction has been thought to better simulate the anterior cruciate ligament anatomy. It is, however, a technically challenging procedure, associated with longer operation time and higher cost. Hypothesis Double-bundle anterior cruciate ligament reconstruction using a single femoral and tibial tunnel can closely reproduce intact knee kinematics. Study Design Controlled laboratory study. Methods Eight fresh-frozen human cadaveric knee specimens were tested using a robotic testing system to investigate the kinematic response of the knee joint under an anterior tibial load (130 N), simulated quadriceps load (400 N), and combined torques (5 N·m valgus and 5 N·m internal tibial torques) at 0°, 15°, 30°, 60°, and 90° of flexion. Each knee was tested sequentially under 4 conditions: (1) anterior cruciate ligament intact, (2) anterior cruciate ligament deficient, (3) single-bundle anterior cruciate ligament reconstruction using quadrupled hamstring tendon, and (4) single-tunnel–double-bundle anterior cruciate ligament reconstruction using the same tunnels and quadrupled hamstring tendon graft as in the single-bundle anterior cruciate ligament reconstruction. Results Single-tunnel–double-bundle anterior cruciate ligament reconstruction more closely restored the intact knee kinematics than single-bundle anterior cruciate ligament reconstruction at low flexion angles (?30°) under the anterior tibial load and simulated muscle load (P < .05). However, single-tunnel–double-bundle anterior cruciate ligament reconstruction overconstrained the knee joint at high flexion angles (?60°) under the anterior tibial load and at 0° and 30° of flexion under combined torques. Conclusion This double-bundle anterior cruciate ligament reconstruction using a single tunnel can better restore anterior tibial translations to the intact level compared with single-bundle anterior cruciate ligament reconstruction at low flexion angles, but it overconstrained the knee joint at high flexion angles. Clinical Relevance This technique could be an alternative for both single-bundle and double-tunnel–double-bundle anterior cruciate ligament reconstructions to reproduce intact knee kinematics and native anterior cruciate ligament anatomy.

Gadikota, Hemanth R.; Seon, Jong Keun; Kozanek, Michal; Oh, Luke S.; Gill, Thomas J.; Montgomery, Kenneth D.; Li, Guoan

2013-01-01

124

To Study the Incidence of Heterotopic Ossification After Anterior Cruciate Ligament Reconstruction  

PubMed Central

Introduction: Previous studies have enumerated the advantages of an arthroscopic Anterior Cruciate Ligament (ACL) reconstruction with the use of a Bone Patellar Tendon Bone (BPTB) graft. Complications are extremely rare in such surgeries and one such known complication, which is an extra-articular heterotophic ossification at the femoral tunnel site, is rarely seen only in few patients. Aim: To evaluate the incidence of heterotrophic ossifications at the femoral tunnel site and the efficacy of the preventive measures which were undertaken, in patients who had undergone ACL reconstructions with the use of bone patellar tendon bone grafts. Material and Methods: A total of 285 patients who had ACL tears within a duration of six years, were evaluated prospectively for the incidence of heterotrophic ossifications after they underwent arthroscopic reconstructions with the use of bone patellar tendon bone grafts by the double incision technique. The effect of the efficacy of various preventive measures on the incidence of the heterotophic ossifications post surgery was also studied. Results: The observed incidence of the heterotophic ossifications was 2.58% in patients whom preventive measures were not used. In contrast, an incidence of 1.54% of similar complications was recorded, after preventive measures were undertaken. Our results showed that heterotophic ossifications after arthroscopic reconstructions with the use of bone patellar tendon bone grafts were a rare complication and that their incidence could be further reduced if preventive measures were taken. Conclusion: The heterotophic ossification is a rare complication after an ACL reconstruction is done with the use of a bone patellar tendon bone graft by the double incision technique. Its incidence reduces significantly after preventive measures are undertaken.

Bhandary, Bhaskara; Shetty, Sudeep; Bangera, Vinay V.; R., Yogaprakash; Kassim, Mohammed Shabir; Alva, Karan; Bhandary, Sudarshan

2013-01-01

125

To study the incidence of heterotopic ossification after anterior cruciate ligament reconstruction.  

PubMed

Introduction: Previous studies have enumerated the advantages of an arthroscopic Anterior Cruciate Ligament (ACL) reconstruction with the use of a Bone Patellar Tendon Bone (BPTB) graft. Complications are extremely rare in such surgeries and one such known complication, which is an extra-articular heterotophic ossification at the femoral tunnel site, is rarely seen only in few patients. Aim: To evaluate the incidence of heterotrophic ossifications at the femoral tunnel site and the efficacy of the preventive measures which were undertaken, in patients who had undergone ACL reconstructions with the use of bone patellar tendon bone grafts. Material and Methods: A total of 285 patients who had ACL tears within a duration of six years, were evaluated prospectively for the incidence of heterotrophic ossifications after they underwent arthroscopic reconstructions with the use of bone patellar tendon bone grafts by the double incision technique. The effect of the efficacy of various preventive measures on the incidence of the heterotophic ossifications post surgery was also studied. Results: The observed incidence of the heterotophic ossifications was 2.58% in patients whom preventive measures were not used. In contrast, an incidence of 1.54% of similar complications was recorded, after preventive measures were undertaken. Our results showed that heterotophic ossifications after arthroscopic reconstructions with the use of bone patellar tendon bone grafts were a rare complication and that their incidence could be further reduced if preventive measures were taken. Conclusion: The heterotophic ossification is a rare complication after an ACL reconstruction is done with the use of a bone patellar tendon bone graft by the double incision technique. Its incidence reduces significantly after preventive measures are undertaken. PMID:23814735

Bhandary, Bhaskara; Shetty, Sudeep; Bangera, Vinay V; R, Yogaprakash; Kassim, Mohammed Shabir; Alva, Karan; Bhandary, Sudarshan

2013-03-28

126

No-tunnel anterior cruciate ligament reconstruction: the transtibial all-inside technique.  

PubMed

The purpose of this technical note is to describe the transtibial all-inside anterior cruciate ligament (ACL) reconstruction technique. This technique combines the advantages of previously described but technically demanding all-inside ACL reconstruction techniques with the ease and familiarity of transtibial guide pin placement. The all-inside technique uses bone sockets as opposed to bone tunnels in both the femur and the tibia and represents a "no-tunnel" technique. When performed with allograft tissue, the method requires only arthroscopic portals and percutaneous guide pin passage. In such cases, this represents a "no-incision" ACL reconstruction. The technique requires the use of a Dual Retrocutter (Arthrex, Naples, FL). This cannulated drill is placed via the anteromedial arthroscopic portal and threads onto a transtibial, percutaneous, reverse-threaded guide pin. Because the drill is assembled arthroscopically (within the joint), a skin incision is not required. The Dual Retrocutter is capable of retrograde and antegrade drilling. Thus, a single Dual Retrocutter achieves transtibial drilling of both tibial and femoral bone sockets. The transtibial all-inside technique may be performed with the use of any ACL graft option. Graft diameter should equal socket diameter. To prevent the graft from "bottoming-out" during tensioning and fixation, graft length must be less than the sum of combined femoral plus tibial socket lengths plus ACL intra-articular distance. During the learning curve, surgeons may choose to wait until the sockets have been prepared, so that graft length need not be estimated. If the graft is prepared before arthroscopic surgery is performed, a 79-mm graft length could be recommended as ideal. To prepare for graft passage, both femoral and tibial graft passing suture loops must be brought out the anteromedial arthroscopic portal without soft tissue interposition between or within the loops. To prepare for graft fixation, a nitinol wire must be brought into the joint via the transtibial, percutaneous guide pin tract for the purpose of guiding the introduction of a cannulated Retroscrewdriver. All of these goals may be accomplished in a single pass. The graft is fixed with femoral and tibial Retroscrews. Backup fixation is optional and may be achieved by tying sutures over small, percutaneously placed cortical buttons. Advantages of this technique may result from "anatomic" graft fixation at the levels of the femoral and tibial joint lines and from retrograde screw fixation, which may eliminate interference screw divergence and increase graft tension when the retrograde screw is advanced. Additionally, because this technique minimizes skin incisions and eliminates open bone tunnels, patients may experience decreased pain, more rapid return to function, and improved cosmesis. PMID:16904591

Lubowitz, James H

2006-08-01

127

Ultrasound evaluation of gravity induced anterior drawer following anterior cruciate ligament lesion  

Microsoft Academic Search

Ultrasound is not so far a standard procedure to visualize the anterior drawer following anterior cruciate ligament (ACL)\\u000a lesions. This is because the described techniques are either technically difficult or depend on the experience of the performer\\u000a and are not standardized. The purpose of this prospective analysis on ACL intact, ACL deficient and ACL reconstructed knees\\u000a was to compare the

F. Gebhard; M. Authenrieth; W. Strecker; L. Kinzl; G. Hehl

1999-01-01

128

In vivo kinematics of anterior cruciate ligament deficient knees during pivot and squat activities  

Microsoft Academic Search

BackgroundKnee kinematics during pivoting activities are not well studied, but might provide insight critical to understanding the pathology of the anterior cruciate ligament deficient knee. The purpose of this study was to compare in vivo kinematics during weight bearing pivot and squat activities in patients with unilateral anterior cruciate ligament deficient knees, and to contrast those kinematics with the uninjured

Satoshi Yamaguchi; Kazuyoshi Gamada; Takahisa Sasho; Hideyuki Kato; Masaki Sonoda; Scott A. Banks

2009-01-01

129

Trunk position modulates anterior cruciate ligament forces and strains during a single-leg squat  

Microsoft Academic Search

BackgroundAlthough the squat exercise and its variations are commonly prescribed for anterior cruciate ligament rehabilitation, whether trunk position affects these ligament forces and strains during the squat is unclear. Our purpose was to evaluate the effects of trunk position on anterior cruciate ligament forces and strains during a single-leg squat.

Anthony S. Kulas; Tibor Hortobágyi; Paul DeVita

130

The Long-term Consequence of Anterior Cruciate Ligament and Meniscus InjuriesOsteoarthritis  

Microsoft Academic Search

The objectives of this study are to review the long-term consequences of injuries to the anterior cruciate ligament and menisci, the pathogenic mechanisms, and the causes of the considerable variability in outcome. Injuries of the anterior cruciate ligament and menisci are common in both athletes and the general population. At 10 to 20 years after the diagnosis, on average, 50%

L. Stefan Lohmander; P. Martin Englund; Ludvig L. Dahl; Ewa M. Roos

2007-01-01

131

The Remains of Anterior Cruciate Ligament Graft Tension After Cyclic Knee Motion  

Microsoft Academic Search

Background: There is sometimes a return of excess knee laxity after anterior cruciate ligament reconstruction. One of the contributing factors might be a loss in graft tension. It is unknown whether the tension imposed on an anterior cruciate ligament graft degrades with time and, if so, the effect of that loss of tension on knee laxity.Hypotheses: The pretension in the

Markus P. Arnold; Denny T. T. Lie; Nico Verdonschot; Ruurd de Graaf; Andrew A. Amis; Albert van Kampen

2005-01-01

132

The effect of the walking speed on the stability of the anterior cruciate ligament deficient knee  

Microsoft Academic Search

Background. The reasons behind the development of future pathology in individuals with anterior cruciate ligament deficiency are unknown. This is due to the lack of appropriate methods to assess functional dynamic knee stability. In this study, we investigated the effect of walking speed on the functional dynamic stability of the anterior cruciate ligament deficient knee. We defined functional dynamic stability

Nicholas Stergiou; Constantina Moraiti; Giannis Giakas; Stavros Ristanis; Anastasios D. Georgoulis

2004-01-01

133

[Septic knee arthritis caused by Pseudomonas aeruginosa after anterior cruciate ligament reconstruction in an adolescent athlete].  

PubMed

Anterior cruciate ligament reconstruction is a very frequent procedure. Postoperative infection after this procedure is a catastrophic, although infrequent, complication. According to the literature, it occurs in less than 1% of all reconstructions done in the United States. We present herein a case report of septic arthritis of the posterior knee associated with anterior cruciate ligament reconstruction. PMID:23320342

De la Garza-Castro, S; González-Rivera, C E; Vilchez-Cavazos, J F; Rositas-Noriega, F H; Mendoza-Lemus, O F

134

Anterior cruciate ligament reconstruction with a braided ultrahigh molecular weight polyethylene prosthesis  

Microsoft Academic Search

The purpose of this study was to evaluate the use of a prosthetic anterior cruciate ligament (PACL) for the treatment of anterior cruciate ligament (ACL) deficient knees. Fifteen patients (mean age, 40 years; range, 27 to 51 years) underwent ACL reconstruction using a PACL made from ultrahigh molecular weight polyethylene. Eleven patients had chronic ACL insufficiency (greater than 26 weeks),

Andrew S. Rokito; Clarence L. Shields; Matthew R. Lee

1995-01-01

135

Evidence of Reinnervation of Free Patellar Tendon Autograft Used for Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

We studied six adult male dogs to determine whether free patellar tendon grafts show evidence of reinner vation when used for anterior cruciate ligament recon struction. Histologic return of neural elements and re turn of a somatosensory-evoked potential defined evidence of reinnervation. Before removal, the native anterior cruciate ligament was electrically stimulated with a bipolar electrode and a somatosensory-evoked potential

Robert L. Barrack; Peter J. Lund; Barry G. Munn; Carole Wink; Leo Happel

1997-01-01

136

Anterior cruciate ligament healing and advances in imaging.  

PubMed

Graft healing and maturation are important considerations during the rehabilitation process. Histologic studies have identified the stages of graft healing following anterior cruciate ligament (ACL) reconstruction. Correlations between histology and radiographic findings have allowed for the development of noninvasive methods to assess graft maturity. Important information regarding graft vascularity and incorporation of the graft to host bone can be obtained from imaging modalities. The role of noninvasive means in the evaluation of patients following ACL reconstruction continues to develop as these powerful tools evolve. PMID:23177458

Rabuck, Stephen J; Baraga, Michael G; Fu, Freddie H

2012-10-04

137

Mucoid degeneration of the anterior cruciate Ligament: a case report  

PubMed Central

We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). Mucoid degeneration of the ACL is a very rare cause of knee pain. There have been only some reported cases of mucoid degeneration of the ACL in the English literature. We reviewed previous reports and summarized clinical features and symptoms, including those found in our case. Magnetic Resonance Imaging is the most useful tool for differentiating mucoid degeneration of the ACL from an intraligamentous ganglion or other lesions in the knee joint. If this disease is considered preoperatively, it can be diagnosed easily based on characteristic findings.

el Kadi, Khalid Ibn; Marcaillou, Florian; Blanc, Stephane; Salloum, Bassam; Dimontagliari, Cyril; Boutayeb, Fawzi

2013-01-01

138

Prevention of anterior cruciate ligament injury in the female athlete.  

PubMed

The relationships of gender, age and training to the incidence of anterior cruciate ligament (ACL) injury are pivotal to developing a comprehensive neuromuscular and proprioceptive training programme to decrease ACL injuries in female athletes. A prophylactic neuromuscular and proprioceptive training programme may have direct benefit in decreasing the number of ACL injuries in female athletes. This research foundation endorses further epidemiological and biomechanical studies to determine the exact mechanism of ACL injury and the most effective intervention for decreasing ACL injuries in this high-risk population. PMID:17609222

Silvers, Holly Jacinda; Mandelbaum, Bert R

2007-07-03

139

Gender Differences in Anterior Cruciate Ligament Injury Vary With ActivityEpidemiology of Anterior Cruciate Ligament Injuries in a Young, Athletic Population  

Microsoft Academic Search

Background: Previous studies have shown that women involved in similar activities as men are at increased risk for anterior cruciate ligament injuries.Hypothesis: The incidence rate of complete anterior cruciate ligament tears for men and women in our athletic, college-aged population is similar.Study Design: Descriptive epidemiology study.Methods: Students graduating in class years 1994 to 2003 at our institution who sustained complete

Sally B. Mountcastle; Matthew Posner; John F. Kragh; Dean C. Taylor

2007-01-01

140

The effect of progressive degrees of medial meniscal loss on stability after anterior cruciate ligament reconstruction.  

PubMed

Previous studies report conflicting results on whether loss of the medial meniscus compromises knee stability after reconstruction of the anterior cruciate ligament (ACL). The purpose of this study was to determine whether the degree of medial meniscus deficiency affects the stability of the ACL-reconstructed knee. Six cadaveric knees were arthroscopically reconstructed with bone-patellar tendon-bone autografts using an anatomic "footprint" technique. Knees tested were ACL-deficient and after reconstruction under three different meniscal states: with partial medial meniscectomy, subtotal meniscectomy, and meniscal root transection. Biomechanical testing was performed at 30 and 60 degrees of flexion under two loading conditions: (1) 134-N anterior tibial load termed anterior tibial translation (ATT) and (2) 10-Nm valgus load combined with 5 Nm of internal tibial torque termed provocative pivot maneuver (PPM). Knee kinematics was measured using a custom activity simulator, motion analysis system, and three-dimensional CT reconstructions. During both ATT and PPM loading, ACL deficiency resulted in a significant increase in anterior translation compared with knees with an intact ACL or those that had undergone ACL reconstruction (p < 0.05). Neither the addition of a partial nor subtotal medial meniscectomy led to increased instability. Only after medial meniscal root transection was increased instability of the ACL-deficient knee detected compared with intact, partial, or subtotal meniscectomy states (p < 0.01). In all states of meniscal deficiency, ACL reconstruction restored internal tibial rotation and anterior translation at 30 degrees to that of the intact knee (p > 0.05). Anatomic single bundle ACL reconstruction was able to restore knee stability in all conditions of medial meniscal deficiency. PMID:23512542

McCulloch, Patrick C; Shybut, Theodore B; Isamaily, Sabir K; Durrani, Salim; Gold, Johnathan E; Noble, Philip C; Lintner, David M

2013-03-19

141

ARTROSKOPSKO ZDRAVLJENJE ANTERIORNE UTESNITVE V ZGORNJEM SKO?NEM SKLEPU ARTHROSCOPIC TREATMENT OF ANTERIOR IMPINGEMENT IN THE ANKLE  

Microsoft Academic Search

Background. Anterior soft tissue impingement is a common cause of chronic pain in the ankle. The preferred method of operative treatment is an arthroscopic excision of hypertrophic fibrous and synovial tissue in the anterior part of the ankle joint. Methods. We present the results of arthroscopic treatment of anterior ankle impingement in group of 14 patients. Results. Subjective improvement after

Martin Mikek; Mohsen Hussein

142

A New Anterior Cruciate Ligament Reconstruction Fixation Technique (Quadrupled Semitendinosus Anterior Cruciate Ligament Reconstruction With Polyetheretherketone Cage Fixation)  

PubMed Central

Fixation of the graft during anterior cruciate ligament reconstruction surgery has been the subject of numerous technical innovations but still remains a challenge. This article describes a novel technique of graft fixation for hamstring tendon reconstruction: the Cage For One system (Sacimex, Aix-en-Provence, France). The technique uses only the semitendinosus tendon, which is looped to create a 4-strand graft. Leaving the gracilis tendon intact probably reduces the loss of knee flexion strength. The graft is indirectly anchored into both tunnels with polyetheretherketone cages by use of polyethylene terephthalate tape strips. Both cages and strips are magnetic resonance imaging compatible and do not create artifacts. The tunnels are drilled by an outside-in method with minimal incisions. This type of fixation creates a 360° bone contact at 1.5 cm in each tunnel and is compatible with double-bundle reconstruction. This easy-to-use novel technique of fixation for anterior cruciate ligament reconstruction produces a strong 4-strand graft while harvesting only the semitendinosus tendon and leaving the gracilis tendon intact to reduce flexion strength loss and preserve rotatory stability of the knee. It creates an immediate solid fixation that is independent of graft integration in the early postoperative period, allowing the patient to start immediate rehabilitation without the use of a brace.

Calas, Philippe; Dorval, Nicolas; Bloch, Anthony; Argenson, Jean-Noel; Parratte, Sebastien

2012-01-01

143

A new anterior cruciate ligament reconstruction fixation technique (quadrupled semitendinosus anterior cruciate ligament reconstruction with polyetheretherketone cage fixation).  

PubMed

Fixation of the graft during anterior cruciate ligament reconstruction surgery has been the subject of numerous technical innovations but still remains a challenge. This article describes a novel technique of graft fixation for hamstring tendon reconstruction: the Cage For One system (Sacimex, Aix-en-Provence, France). The technique uses only the semitendinosus tendon, which is looped to create a 4-strand graft. Leaving the gracilis tendon intact probably reduces the loss of knee flexion strength. The graft is indirectly anchored into both tunnels with polyetheretherketone cages by use of polyethylene terephthalate tape strips. Both cages and strips are magnetic resonance imaging compatible and do not create artifacts. The tunnels are drilled by an outside-in method with minimal incisions. This type of fixation creates a 360° bone contact at 1.5 cm in each tunnel and is compatible with double-bundle reconstruction. This easy-to-use novel technique of fixation for anterior cruciate ligament reconstruction produces a strong 4-strand graft while harvesting only the semitendinosus tendon and leaving the gracilis tendon intact to reduce flexion strength loss and preserve rotatory stability of the knee. It creates an immediate solid fixation that is independent of graft integration in the early postoperative period, allowing the patient to start immediate rehabilitation without the use of a brace. PMID:23766974

Calas, Philippe; Dorval, Nicolas; Bloch, Anthony; Argenson, Jean-Noël; Parratte, Sébastien

2012-03-31

144

Outcomes following healing response in older, active patients: a primary anterior cruciate ligament repair technique.  

PubMed

The purpose of this study was to document outcomes following the healing response procedure for treatment of complete, proximal anterior cruciate ligament (ACL) tears in a mature, active population. Healing response is an all-arthroscopic procedure that preserves the native ACL and makes use of an arthroscopic awl with a 45-degree angle to make holes in the femoral attachment of the ACL and in the body of the ACL. Patients were included in this IRB-approved study if they were > or =40 years old, had a complete proximal ACL tear, and who had healing response within 6 weeks of initial injury. In this study 48 patients (35 females, 13 males) with an average age of 51 years (range: 41 to 68 years) underwent the healing response procedure. Of these four female patients (8.9%) required subsequent ACL reconstruction. Mean time to ACL reconstruction was 34.5 months (range, 14.3 to 61.2 months). Of the 44, 41 patients (93%) had minimum of 2-year follow-up at an average of 7.6 years (range, 2.2 to 13.4 years). Average preoperative Lysholm score was 54 (range, 10 to 82) and improved to an average of 90 postoperatively (p = 0.001). Median Tegner activity scale at follow-up was 5 (range, 2 to 9). Median patient satisfaction was 10 (range, 4 to 10). Higher patient satisfaction was correlated with increased Lysholm score at follow-up (rho = 0.39, p = 0.02). Tegner activity scale was associated with postoperative Lysholm score (rho = 0.35, p = 0.04). This study demonstrates the effectiveness of the healing response procedure to allow patients to return to high levels of recreational activity and to restore knee function to normal levels. In a select group of mature patients with acute proximal ACL tears, the healing response procedure is an effective treatment technique. PMID:23057146

Steadman, J Richard; Matheny, Lauren M; Briggs, Karen K; Rodkey, William G; Carreira, Dominic S

2012-07-01

145

Arthroscopic repair of isolated type II superior labrum anterior–posterior lesion  

Microsoft Academic Search

The effectiveness of arthroscopic repair of type II superior labrum anterior–posterior lesion (SLAP) was unclear as previous\\u000a studies examined this treatment with patients of combined types of SLAP lesions. To address this research gap, we evaluated\\u000a the clinical and functional outcomes of arthroscopic repair for 16 patients (mean = 24.2, SD = 6.5) with clinical evidence\\u000a of isolated type II SLAP lesion. After having

Patrick Shu-Hang Yung; Daniel Tik-Pui Fong; Ming-Fat Kong; Chun-Kong Lo; Kwai-Yau Fung; Eric Po-Yan Ho; Derwin King-Chung Chan; Kai-Ming Chan

2008-01-01

146

The story of anterior cruciate ligament reconstruction--Part 1.  

PubMed

Once upon a time the anterior cruciate ligament (ACL) enjoyed a relatively unchartered existence, when only a fall from a jousting horse or chariot might have sent a knight or gladiator into early retirement due to an unstable knee. In today's world of high speed travel and an ever increasing number of sports enthusiasts, injuries of the ACL are almost common place with a yearly incidence of about 35 per 100,000 of the population. Although we have known about the existence of the cruciate ligaments since they were first described by Galen over 2000 years ago, awareness of their function and the consequences of their loss were not appreciated until much later. Robert Adams observed the first clinical case of an ACL tear in 1837 but treatment in those days was largely conservative and surgery was reserved for life threatening conditions as mortality was high. The first ACL repair was performed in 1895 by Mayo-Robson of Leeds and was followed by Grekow and Hey Groves who initiated ACL reconstruction with autologous tissue between 1914 and 1920, almost as we know it today. PMID:22720509

Schindler, Oliver S

2012-05-01

147

Knee extension and flexion: MR delineation of normal and torn anterior cruciate ligaments  

SciTech Connect

Our goal was to assess the effect of joint position of semiflexed and extended knees in MR delineation of the anterior cruciate ligament (ACL). With a mobile knee brace and a flexible surface coil, the knee joint was either fully extended or bent to a semiflexed position (average 45{degrees} of flexion) within the magnet bore. Sets of oblique sagittal MR images were obtained for both extended and flexed knee positions. Thirty-two knees with intact ACLs and 43 knees with arthroscopically proven ACL tears were evaluated. Two observers compared paired MR images of both extended and flexed positions and rated them by a relative three point scale. Anatomic correlation in MR images was obtained by a cadaveric knee with incremental flexion. The MR images of flexed knees were more useful than of extended knees in 53% of the case reviews of femoral attachments and 36% of reviews of midportions of normal ACLs. Compared with knee extensions, the MR images for knee flexion provided better clarity in 48% of reviews of disrupted sites and 52% of residual bundles of torn ACLs. Normal ACL appeared taut in the knee extension and lax in semiflexion. Compared with MR images of knees in extension, MR images of knees in flexion more clearly delineate the femoral side of the ligament with wider space under the intercondylar roof and with decreased volume-averaging artifacts, providing superior visualization of normal and torn ACLs. 13 refs., 7 figs., 1 tab.

Niitsu, Mamoru; Ikeda, Kotaroh; Fukubayashi, Tohru; Anno, Izumi; Itai, Yuji [Univ. of Tsukuba, Ibaraki (Japan)

1996-03-01

148

Validation of the Thessaly test for detecting meniscal tears in anterior cruciate deficient knees.  

PubMed

Meniscal injuries are frequently associated with anterior cruciate ligament (ACL) tears. Clinical tests that are useful for detecting meniscal tears may not be valid in this setting. The Thessaly test, a newly described dynamic clinical examination, has been shown to have a very high diagnostic accuracy for detecting meniscal tears. This study evaluates the accuracy of the Thessaly test in patients with combined ACL and meniscus injuries. We examined eighty patients with ACL deficiency for meniscal injuries using the Thessaly test (at 20 degrees of knee flexion), the lateral and medial joint line tenderness tests, and the McMurray test. Examiners were blinded to the MRI report on the conditions of the menisci. All patients underwent arthroscopic ACL reconstruction during which the menisci were evaluated by direct vision and probing. During the Thessaly test, six patients developed severe pain and could not complete the test. Sensitivity, specificity, likelihood ratios and predictive values were calculated for all tests. The Thessaly test had a sensitivity of 79%, specificity of 40%, positive predictive value of 56%, negative predictive value of 66%, positive likelihood ratio of 1.33, negative likelihood ratio of 0.51%, and overall accuracy of 60%. We concluded that the Thesally test has a low specificity in patients with combined ACL and meniscal injuries and can not be recommended as a diagnostic test in this setting. PMID:19751979

Mirzatolooei, Fardin; Yekta, Zahra; Bayazidchi, Mojgan; Ershadi, Solmaz; Afshar, Ahmadreza

2009-09-13

149

Continuous-flow cold therapy for outpatient anterior cruciate ligament reconstruction.  

PubMed

This prospective, randomized study evaluated continuous-flow cold therapy for postoperative pain in outpatient arthroscopic anterior cruciate ligament (ACL) reconstructions. In group 1, cold therapy was constant for 3 days then as needed in days 4 through 7. Group 2 had no cold therapy. Evaluations and diaries were kept at 1, 2, and 8 hours after surgery, and then daily. Pain was assessed using the VAS and Likert scales. There were 51 cold and 49 noncold patients included. Continuous passive movement (CPM) use averaged 54 hours for cold and 41 hours for noncold groups (P=.003). Prone hangs were done for 192 minutes in the cold group and 151 minutes in the noncold group. Motion at 1 week averaged 5/88 for the cold group and 5/79 the noncold group. The noncold group average visual analog scale (VAS) pain and Likert pain scores were always greater than the cold group. The noncold group average Vicodin use (Knoll, Mt. Olive, NJ) was always greater than the cold group use (P=.001). Continuous-flow cold therapy lowered VAS and Likert scores, reduced Vicodin use, increased prone hangs, CPM, and knee flexion. Continuous-flow cold therapy is safe and effective for outpatient ACL reconstruction reducing pain medication requirements. PMID:9531122

Barber, F A; McGuire, D A; Click, S

1998-03-01

150

Anterior cruciate ligament reconstruction graft harvesting: pitfalls and tips.  

PubMed

Surgical treatment for anterior cruciate ligament deficiency has relied predominantly on reconstruction with autografts. Grafts taken from patients' own central third of their patellar tendon, bone-patellar tendon bone, or one or more of the hamstring tendons, semitendinosus, and gracilis, constitute the majority of grafts used for these purposes. Although there is no single graft option that clearly outperforms another, an abundance of articles replete with complications associated with harvest and use are available from peer-reviewed journals. It is these complications and their prevention that will be addressed in the following chapter. The idea in mind is that the reader might adopt these techniques to improve their patient outcomes by minimizing, or eliminating, the ongoing problems that such complications produce. PMID:18004217

McGuire, David A; Hendricks, Stephen D

2007-12-01

151

Clinics in diagnostic imaging. 141. Complete anterior cruciate ligament tear.  

PubMed

A 38-year-old man presented with right knee pain and swelling following a football injury. Magnetic resonance (MR) imaging showed a complete anterior cruciate ligament (ACL) tear and lateral meniscal tears. The torn ACL was repaired with a graft obtained from the semitendinosus muscle, and the menisci were debrided. The mechanisms of injury to the ACL are varied and may be due to direct or indirect contact with the knee as well as with twisting injuries. Knowledge of the ACL's normal anatomy, together with MR imaging technique and understanding of the appearance of the lesion on MR examination, is crucial to aid in the identification of an ACL tear. Diagnosis of an ACL tear should be based on direct MR imaging signs, although indirect signs may be helpful, particularly in chronic tears. Other associated injuries to be aware of include meniscal and other ligamentous injuries. Normal ACL graft and post-ACL graft reconstruction complications are also briefly discussed. PMID:23023908

Lim, Hollie M Y; Peh, Wilfred C G

2012-09-01

152

Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies.  

PubMed

An estimated 80,000 anterior cruciate ligament (ACL) tears occur annually in the United States. The highest incidence is in individuals 15 to 25 years old who participate in pivoting sports. With an estimated cost for these injuries of almost a billion dollars per year, the ability to identify risk factors and develop prevention strategies has widespread health and fiscal importance. Seventy percent of ACL injuries occur in noncontact situations. The risk factors for non-contact ACL injuries fall into four distinct categories: environmental, anatomic, hormonal, and biomechanical. Early data on existing neuromuscular training programs suggest that enhancing body control may decrease ACL injuries in women. Further investigation is needed prior to instituting prevention programs related to the other risk factors. PMID:10874221

Griffin, L Y; Agel, J; Albohm, M J; Arendt, E A; Dick, R W; Garrett, W E; Garrick, J G; Hewett, T E; Huston, L; Ireland, M L; Johnson, R J; Kibler, W B; Lephart, S; Lewis, J L; Lindenfeld, T N; Mandelbaum, B R; Marchak, P; Teitz, C C; Wojtys, E M

153

Anterior cruciate ligament injuries in the female athlete.  

PubMed

The normal anterior cruciate ligament (ACL) is critical to knee joint stability, especially for athletes in cutting sports. Rupture of the ACL can be a devastating, if not career-ending, injury for a young athlete because of the resultant instability and increased risk of meniscal and chondral damage. Considerably more girls and women than ever before now participate in athletics. Some epidemiologic data show that female athletes may sustain a higher incidence of ACL injuries than male athletes. Risk factors that may be responsible for these increased injury rates are reviewed. History and physical examination are most important in establishing the diagnosis of ACL injury, although ancillary diagnostic imaging is helpful if the extent of injury is in question. Treatment options, including various surgical reconstructions and rehabilitation, are discussed, with attention to the specific concerns of the female athlete. With appropriate diagnosis and treatment, the ACL-injured athlete may now anticipate full return to function and athletic competition. PMID:9580914

Baker, M M

1998-04-01

154

[History of implant-free anterior cruciate ligament reconstruction].  

PubMed

Most recent articles on anterior cruciate ligament (ACL) reconstruction focus on anatomic tunnel placement, but reviewing the early history of ACL reconstruction it can be seen that at the beginning of the 20th century Ernest Hey-Groves had already pointed out the importance of anatomic placement of the tunnels. Palmer even developed a femoral drill guide for precise anatomic placing of the tunnel before World War II. The possibility of graft fixation without any fixation material is also not new and was described as early as 1967 by Brückner from Rostock. Many techniques in ACL reconstruction with non-anatomic placement and high failure rates could have been avoided if surgeons had been aware of what the early pioneers in this important field of orthopedic surgery had already described. PMID:20632224

Pässler, H H

2010-07-01

155

Relationship between mucoid hypertrophy of the anterior cruciate ligament (ACL) and morphologic change of the intercondylar notch: MRI and arthroscopy correlation  

Microsoft Academic Search

Objective  The purpose of this study was to evaluate the relationship between mucoid hypertrophy of the anterior cruciate ligament (ACL)\\u000a and morphologic change of the intercondylar notch.\\u000a \\u000a \\u000a \\u000a Materials and methods  We retrospectively reviewed the 105 patients with knee magnetic resonance imaging (MRI) with or without knee arthroscopy [group\\u000a 1: patients with arthroscopic notchplasty (N?=?47), group 2: knee arthroscopy demonstrating intact ACL (N?=?33),

Ji Hyeon Cha; Sang Hoon Lee; Myung Jin Shin; Byeong Kyoo Choi; Sung Il Bin

2008-01-01

156

Effects of knee bracing on the functional performance of patients with anterior cruciate ligament reconstruction  

Microsoft Academic Search

Wu GKH, Ng GYF, Mak AFT. Effects of knee bracing on the functional performance of patients with anterior cruciate ligament reconstruction. Arch Phys Med Rehabil 2001;82:282-5. Objective: To compare the functional performance of subjects with unilateral anterior cruciate ligament (ACL) reconstruction. Design: Cross-sectional comparative clinical trial. Setting: A physical therapy outpatient department. Subjects: Thirty-one subjects with unilateral ACL reconstruction for

Gloria K. H. Wu; Gabriel Y. F. Ng; Arthur F. T. Mak

2001-01-01

157

[Temporary postoperative protection of the anterior cruciate ligament with transarticular wire rope].  

PubMed

This article describes an operational method for the temporary protection of the anterior cruciate ligament after acute or late ligament reconstruction. In line with the course of the anterior cruciate ligament a wire rope is transarticularly implanted and fixed with a screw each at the femur (proximally) and at the tibia bone (distally). This easily performed method permits both the healing of the ligament lesion while preserving the original ligament length and the execution of an early functional exercise therapy. PMID:1971482

Weigand, H; Storm, H; Birne, F U

1990-04-01

158

Loading response following anterior cruciate ligament reconstruction during the parallel squat exercise  

Microsoft Academic Search

Objective. To determine if individuals 1.5–15 months post-anterior cruciate ligament reconstruction demonstrated an equal loading response on their involved and uninvolved lower extremity during a parallel squat exercise versus a control group.Design. Four-group repeated measures design with one between-subject factor (time post-anterior cruciate ligament reconstruction) and two within-subject factors (knee angle and added weight).Background. It has been a clinical observation

Jennifer A. Neitzel; Thomas W. Kernozek; George J. Davies

2002-01-01

159

Acceleration of Tendon-Bone Healing of Anterior Cruciate Ligament Graft Using Autologous Ruptured Tissue  

Microsoft Academic Search

Background: It has been recently reported that human anterior cruciate ligament (ACL) ruptured tissue contains abundant vascular stem cells that contribute to tendon-bone healing in an immunodeficient rat model of ACL reconstruction.Hypothesis: Autologous ruptured ACL tissue has an effect on the maturation of bone-tendon integration in anterior cruciate ligament reconstruction.Study Design: Controlled laboratory study.Methods: Twenty healthy adult beagle dogs underwent

Tomoyuki Matsumoto; Seiji Kubo; Ken Sasaki; Yohei Kawakami; Shinya Oka; Hiroshi Sasaki; Koji Takayama; Katsumasa Tei; Takehiko Matsushita; Yutaka Mifune; Masahiro Kurosaka; Ryosuke Kuroda

2012-01-01

160

Osseous injury associated with acute tears of the anterior cruciate ligament  

Microsoft Academic Search

Multiplanar spin-echo magnetic resonance imaging was performed on 54 patients with acute complete anterior cruciate ligament tears. Imaging was done within 45 days of index anterior cruciate ligament injury. Spin- echo T1- and T2-weighted images were used to deter mine the lesion morphology and location. Only the T2- weighted sagittal images were used for the incidence assessment; T2-weighted spin-echo imaging

Kevin P. Speer; Charles E. Spritzer; Frank H. Bassett; John A. Feagin; William E. Garrett

1992-01-01

161

Longitudinal Tear of the Medial Meniscus Posterior Horn in the Anterior Cruciate Ligament–Deficient Knee Significantly Influences Anterior Stability  

Microsoft Academic Search

Background: Longitudinal tears of the medial meniscus posterior horn (MMPH) are commonly associated with a chronic anterior cruciate ligament (ACL) deficiency. Many studies have demonstrated the importance of the medial meniscus in terms of limiting the amount of anterior-posterior tibial translation in response to anterior tibial loads in ACL-deficient knees.Hypothesis: An MMPH tear in an ACL-deficient knee increases the anterior-posterior

Jin Hwan Ahn; Tae Soo Bae; Ki-Ser Kang; Soo Yong Kang; Sang Hak Lee

2011-01-01

162

Correlation between trochlear dysplasia and anterior cruciate ligament injury.  

PubMed

PURPOSE. To evaluate the correlation between trochlear dysplasia and anterior cruciate ligament (ACL) injury METHODS. Magnetic resonance images (MRIs) of 95 knees in 54 males and 36 females aged 4 to 74 (mean, 28) years who had anterior knee pain and suspected ligamentous injury were reviewed. The MRIs were independently reviewed by 2 musculoskeletal radiologists on 2 occasions. According to the Dejour classification, trochlear dysplasia was classified into types A, B, C, and D. Intra-articular injuries/ disorders of the patients included patellofemoral osteoarthritis, chondromalacia patella, meniscal tears, and ligamentous injuries. Intra- and inter-observer variability was calculated. RESULTS. 58 of the knees had trochlear dysplasia, 38 of which were Dejour type A. The intra- and inter-observer variability was good to excellent (Kappa=0.76-1). ACL tear was the most common injury (n=13). No ACL injury occurred in patients without trochlear dysplasia. The odds of having sustained an ACL injury were 8.8 fold greater in Dejour type-A knees than in non-type-A knees (p=0.023). CONCLUSION. Dejour type-A trochlear dysplasia was associated with ACL injuries. PMID:24014781

Botchu, Rajesh; Obaid, Haron; Rennie, W J

2013-08-01

163

Results of the surgical reconstruction of the anterior cruciate ligament.  

PubMed

Results of the surgical reconstruction of the anterior cruciate ligament (ACL), using as a graft fourfold hamstring tendons (gracilis and semitendinosus) and middle third of the patellar ligament, were compared. In all patients that were participating in this study clinical examination and magnetic resonance showed ACL rupture, and apart from the choice of the graft, surgical technique was identical. We evaluated 112 patients with implemented patellar ligament graft and fourfold hamstring tendons graft six months after the procedure. Both groups were similar according to age, sex, activity level, knee instability level and rehabilitation program. The results showed that there was no significant difference between groups regarding Lysholm Knee score, IKDC 2000 score, activity level, musculature hypotrophy, and knee joint stability 6 months after the surgery. Anterior knee pain incidence is significantly higher in the group with patellar ligament graft (44% vs. 21%). Both groups had a significant musculature hypotrophy of the upper leg of the knee joint that was surgically treated, six months after the procedure. Both grafts showed good subjective and objective results. PMID:22816221

Zeli?, Zoran; Jovanovi?, Savo; Wertheimer, Vjekoslav; Sari?, Gordan; Biuk, Egon; Gulan, Gordan

2012-03-01

164

Two-bundle, four-tunnel anterior cruciate ligament reconstruction.  

PubMed

We reviewed 33 patients who underwent anterior cruciate ligament (ACL) reconstruction using a two-bundle, four-tunnel technique. The posterolateral bundle (PLB) and anteromedial bundle (AMB) were individually reconstructed with gracilis and semitendinosus tendon auto-grafts, respectively, using separate tibial and femoral tunnels. At final follow-up (24 months post surgery, range 18-31) the International Knee Documentation Committee's (IKDC) objective final evaluation scores were 69 A, 19 B, 12% C. The mean global subjective IKDC score was 86+/-12 points. Ninety-four percent of the patients had returned to sport after an average of 9 months following surgery and 75% returned to their preinjury sporting level. One patient had suffered a graft rupture as a result of a further sports injury. Eighty-four percent of the patients had a negative pivot shift (IKDC A), 9% a glide (IKDC B), and 6% a "clunk" (IKDC C). The mean postoperative side-to-side laxity, measured with KT1000 arthrometry at manual maximum, was 0.9 mm (SD 1.9). Eighty-one percent of the patients had less than 3 mm difference, with only one patient having greater than 5 mm. Our early experience with this new technique appears to demonstrate satisfactory results that are at least equivalent to other techniques and show an apparent trend towards improved control of anterior laxity. PMID:16341690

Colombet, Philippe; Robinson, James; Jambou, Stéphane; Allard, Michel; Bousquet, Vincent; de Lavigne, Christophe

2005-12-09

165

Prior anterior cruciate ligament reconstruction complicating intramedullary nailing of a tibia fracture.  

PubMed

As the number of patients with anterior cruciate ligament reconstructions continues to grow, a subpopulation of patients with displaced tibia-fibula fractures will emerge who have had prior anterior cruciate ligament reconstructions. Previous cruciate ligament surgery can complicate the operative treatment of tibia-fibula fractures by intramedullary nailing. Technical complications arise because the tibial tunnel-graft-screw is in the path of insertion of the intramedullary implant. We present a case in which we traced the path of the patellar tendon autograft, adjusted our entry point for the tibial intramedullary canal, and removed the interference screw to facilitate the fracture surgery. This technical note provides an approach to planning intramedullary nailing of the tibia in patients with prior anterior cruciate ligament surgery. PMID:9788381

Roberts, C; John, C; Seligson, D

1998-10-01

166

The “Ligamentization” Process in Anterior Cruciate Ligament Reconstruction: What Happens to the Human Graft? A Systematic Review of the Literature  

Microsoft Academic Search

Background: Surgical anterior cruciate ligament reconstruction using tendon grafts has become the standard to treat the functionally unstable anterior cruciate ligament–deficient knee. Although tendons clearly differ biologically from ligaments, multiple animal studies have shown that the implanted tendons indeed seem to remodel into a ligamentous “anterior cruciate ligament–like” structure.Purpose: The goal of this study was to systematically review the current

Steven Claes; Peter Verdonk; Ramses Forsyth; Johan Bellemans

2011-01-01

167

Otcomes of Anterior Cruciate Ligament Injuries to Running Backs and Wide Receivers in the National Football League  

Microsoft Academic Search

Background: Anterior cruciate ligament injuries are common in professional football players, and their career impact is unclear.Purpose: To quantify the affect of anterior cruciate ligament injuries on professional football player performance.Study Design: Cohort study (prognosis); Level of evidence, 2.Methods: Anterior cruciate ligament injury data from the National Football League were collected during a 5-year period (1998-2002) for running backs and

James L. Carey; G. Russell Huffman; Selene G. Parekh; Brian J. Sennett

2006-01-01

168

Long-term Outcome of Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon AutograftMinimum 13Year Review  

Microsoft Academic Search

Background: Short-term results of anterior cruciate ligament reconstruction are well reported; however, there are no studies evaluating endoscopic reconstruction of the anterior cruciate ligament with a minimum 10-year follow-up.Hypothesis: Anterior cruciate ligament reconstruction with patellar tendon graft affords good subjective results and clinical laxity assessments but may be associated with development of osteoarthritis over the long term.Study Design: Case series;

Lucy J. Salmon; Vivianne J. Russell; Kathryn Refshauge; Deiary Kader; Chris Connolly; James Linklater; Leo A. Pinczewski

2006-01-01

169

The mid- to long-term results of the anterior cruciate ligament reconstruction with hamstring tendons using Transfix technique  

Microsoft Academic Search

In this study, mid to long-term results of anterior cruciate ligament reconstruction with hamstring tendons and Transfix technique\\u000a were evaluated. Anterior cruciate ligament (ACL) reconstruction with four-strand hamstring tendon was performed with Transfix\\u000a technique on 271 (198 males, 73 females; mean age 25.7; 17–52) patients with anterior cruciate ligament ruptures. The patients\\u000a were followed up with clinical examination, Lysholm and

Mehmet Asik; Cengiz Sen; Ibrahim Tuncay; Mehmet Erdil; Cem Avci; Omer F. Taser

2007-01-01

170

Prospective Comparison of Arthroscopic Medial Meniscal Repair TechniqueInside-Out Suture Versus Entirely Arthroscopic Arrows  

Microsoft Academic Search

Background: Medial meniscal repairs are commonly performed with inside-out sutures and entirely arthroscopic with arrows, but few comparative evaluations on failures have been performed.Hypothesis: No differences in failure rates exist between medial meniscal repairs performed with inside-out suture or entirely arthroscopic at the time of anterior cruciate ligament reconstruction.Study Design: Prospective cohort study.Materials: A single surgeon performed 47 consecutive inside-out

Kurt P. Spindler; Eric C. McCarty; Todd A. Warren; Clinton Devin; Jason T. Connor

2003-01-01

171

Arthrometric Curve-Shape Variables to Assess Anterior Cruciate Ligament Deficiency  

PubMed Central

Background Instrumented measurement of asymmetry in anterior-posterior knee laxity is commonly used to assess anterior cruciate ligament integrity. Significant advances in arthrometric technology and data visualization have occurred since first generation arthrometers. However, little has changed with regard to diagnostic criteria employed. To our knowledge, no investigations have assessed the shape of laxity curves to diagnose anterior cruciate ligament (ACL) deficiency. We hypothesized that linear stiffness and compliance after positive curve inflection would be more sensitive and specific to anterior cruciate ligament injury than current measures and would require data from the involved limb only. Methods Laxity curves were obtained from 130 knees on 65 subjects (Anterior Cruciate Injured n=15, Controls n=50) using a CompuKT Knee Ligament Arthrometer. Traditional diagnostic variables and novel descriptive curve-shape variables [(1) inflection point, (2) pre- and post-inflection linear stiffness and (3) a modified compliance index based on the post-inflection linear stiffness] were assessed for sensitivity to anterior cruciate ligament deficiency. Statistical interactions were evaluated using 2-by-2 ANOVA. Findings Significant interactions (p<0.001) were identified for laxity symmetry, stiffness, compliance index and modified compliance index. Modified compliance index predicted anterior cruciate ligament deficiency with the highest sensitivity (93%) and specificity (100%). For a test performed on a single limb, modified compliance index demonstrated 98% sensitivity and 80% specificity. Interpretation The modified compliance index is a highly sensitive and specific measure to diagnose anterior cruciate ligament deficiency, and may serve as a simple and accurate diagnostic tool for individuals without a healthy contralateral limb.

Wordeman, Samuel C.; Paterno, Mark V.; Quatman, Carmen E.; Bates, Nathaniel A.; Hewett, Timothy E.

2012-01-01

172

ANTERIOR IMPINGEMENT OF THE ANKLE TREATED BY ARTHROSCOPIC REMOVAL OF BONY SPURS  

Microsoft Academic Search

We reviewed 17 patients after arthroscopic resection for anterior impingement in the ankle. All had had painful limitation of dorsiflexion which had failed to respond to conservative treatment. Review at an average of 39 months showed very significant improvements in levels of pain, swelling, stiffness, limping and activity. There was a significant improvement in the range of dorsiflexion but not

D. J. OGILVIE-HARRIS; N. MAHOMED; A. DEMAZIERE

1993-01-01

173

Anterior cruciate ligament injuries in young females playing soccer at senior levels.  

PubMed

The aim of this investigation was to study the consequences of anterior cruciate ligament injuries in female soccer players. Special interest was focused on young female soccer players (< 16 years) sustaining anterior cruciate ligament injuries when playing at a senior level, which means playing together with players 19 years or older. In Sweden, all players belonging to an organized soccer club are insured by the same insurance company, the Folksam Insurance Company. Data of all soccer-related knee injuries in females reported to the Folksam Insurance Company between 1994 and 1998 were collected. A questionnaire was sent to 978 females who were registered to have sustained a knee injury before the age of 20 years. The response rate was 79%. Three hundred and ninety-eight female soccer players who had sustained an anterior cruciate ligament injury before the age of 19 years were analysed. Most of their anterior cruciate ligament injuries had been diagnosed using arthroscopy or magnetic resonance imaging (84%). Thirty-eight percent of the players had been injured before the age of 16 years. Of these, 39% were injured when playing in senior teams. When playing in senior teams 59% of the players below the age of 16 years and 44% of the players 16 years or older sustained their ACL injuries during contact situations. At the time of this investigation (2-7 years after the anterior cruciate ligament injury), altogether 78% (n = 311) reported that they had stopped playing soccer. The most common reason (80%) was symptoms from their anterior cruciate ligament-injured knee. It appears that many young female soccer players injure their anterior cruciate ligament when playing at a senior level. Therefore, we suggest that female soccer players under the age of 16 years should be allowed to participate only in practice sessions but not games at a senior level. PMID:12121422

Söderman, K; Pietilä, T; Alfredson, H; Werner, S

2002-04-01

174

Clinical outcome of the arthroscopic management of sports-related “anterior ankle pain”: a prospective study  

Microsoft Academic Search

Anterior impingement syndrome is a generally accepted diagnosis for a condition characterized by anterior ankle pain with\\u000a limited and painful dorsiflexion. The cause can be either soft tissue or bony obstruction. We reviewed 26 (16 male and 10\\u000a female) athletes with a mean age of 27 years treated arthroscopically for symptoms due to soft-tissue (group I, n = 12) and bony

M. H. Baums; E. Kahl; W. Schultz; H.-M. Klinger

2006-01-01

175

Neuromuscular Responses in Individuals with Anterior Cruciate Ligament Repair  

PubMed Central

Objective Knee surgery may alter the neuromuscular response to unexpected perturbations during functional, dynamic tasks. Long latency reflexes (LLR) follow a transcortical pathway and appear to be modifiable by task demands, potentially giving them a role in neuromuscular performance. We examined LLRs of the quadriceps and hamstrings in response to unexpected perturbations in individuals with a repaired anterior cruciate ligament (ACLR) during a weight-bearing task. We also investigated the anticipatory and volitional muscle activity that preceded and followed the LLR to quantify possible reflex adaptations associated with surgical repair. Methods Twelve females with ACLR and twelve healthy female controls performed a single leg squat maneuver, tracking a sinusoidal target. Random perturbations at the start of the flexion phase yielded tracking errors (“overshoot errors”) and triggered compensatory reflex activity. Results ACLR subjects demonstrated greater overshoot error and knee velocity during unexpected perturbations, increased LLR responses, and reduced absolute anticipatory, short-latency reflex, and voluntary quadriceps activity. Conclusions ACLR subjects showed impaired response to perturbation and a distinct EMG profile during a dynamic single leg weight-bearing task. Future research will determine the cause of neural adaptations in those with ACLR. Significance Neuromuscular adaptations may be a viable target for post-ACL injury rehabilitation interventions.

Madhavan, Sangeetha; Shields, Richard K.

2010-01-01

176

The story of anterior cruciate ligament reconstruction--part 2.  

PubMed

The first part of The story of anterior cruciate ligament reconstruction, was published in the previous issue of this journal, and the reader is encouraged to study both parts in order to become better acquainted with the subject. Those who have read the first part will remember that it concerned the historical developments surrounding the ligament's discovery, the acknowledgement of its function and the appreciation of the detrimental effects once it becomes damaged. It also described the efforts of the early pioneers who recognised the need to reestablish ligament function by ways of ligament repair or reconstruction with autologous tissue. The second part, presented here, explores the surgeons' quests to find the ideal graft material by experimenting with various synthetic materials, as well as those derived from animals (xenografts) and other human beings (allografts). It looks at historic efforts to stabilise an unstable knee by means of extra-articular reinforcements which were popular until not too long ago and reviews the developments of the various graft fixation methods available today. Furthermore it evaluates the influence of arthroscopy which revolutionised not just the procedure of ACL reconstruction but knee surgery in general, and also focuses on the more recent developments of double bundle techniques and the recreation of the ligament's native anatomy. PMID:22774653

Schindler, Oliver S

2012-06-01

177

Surgical management of partial tears of the anterior cruciate ligament.  

PubMed

PURPOSE: Partial anterior cruciate ligament (ACL) tears involving the posterolateral (PL) bundle can lead to rotatory laxity of the knee, while tears involving the anteromedial (AM) bundle result in abnormal anteroposterior laxity of the knee. In this systematic review, we examine the best evidence on the management of partial tears of the ACL. METHODS: A comprehensive search of several databases was performed from the inception of the database to December 2011, using various combinations of keywords focusing on clinical outcomes of human patients who had partial tears of ACL and who had undergone ACL augmentation. We evaluated the methodological quality of each article using the Coleman Methodology Score. RESULTS: Ten articles published in peer-reviewed journals were identified (392 males and 242 females), with a mean modified Coleman methodology of 66.1 ± 10.2. Only two studies compared standard ACL reconstruction and augmentation techniques. No study has a sample large enough to allow establishing guidelines. Validated and standardized proprioception assessment methods should be used to report outcomes. Imaging outcomes should be compared to functional outcomes, and a control group consisting of traditional complete ACL reconstruction should be present. CONCLUSION: There is a need to perform appropriately powered randomized controlled trials presenting clinical outcome with homogeneous score systems to allow accurate statistical analysis. ACL augmentation technique, preserving the intact AM or PL bundle of the ACL, is encouraging but currently available evidences are too weak to support his routine use in clinical practice. LEVEL OF EVIDENCE: Systematic review, Level IV. PMID:23263259

Papalia, Rocco; Franceschi, Francesco; Zampogna, Biagio; Tecame, Andrea; Maffulli, Nicola; Denaro, Vincenzo

2012-12-23

178

The concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction.  

PubMed

PURPOSE: To describe the concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction. METHODS: The PubMed/Medline database was searched using keywords pertaining to ACL reconstruction. Relevant articles were reviewed in order to summarize important concepts of individualized surgery in ACL reconstruction. Surgical experiences with case examples are also highlighted. RESULTS: Individualized ACL surgery allows for the customization of surgery to each individual patient. Accounting for graft selection and other characteristics such as anatomy, lifestyle and activity preferences may provide the patient with the best potential for a successful outcome. The surgeon should be comfortable with a variety of graft harvests and surgical techniques when practicing individualized surgery. CONCLUSION: Individualized anatomic ACL reconstruction is founded on the objective evaluation of functional anatomy and individual characteristics, thereby restoring the ACL as closely as possible to the native anatomy and function. The adoption and subsequent use of individualized surgery may facilitate improved clinical as well as objective outcomes, particularly in the long term. LEVEL OF EVIDENCE: V. PMID:23740328

Hofbauer, M; Muller, B; Murawski, C D; van Eck, C F; Fu, F H

2013-06-01

179

Anterior cruciate ligament rupture: differences between males and females.  

PubMed

The rate of anterior cruciate ligament (ACL) rupture is three times higher in female athletes than in male athletes. Intrinsic factors such as increased quadriceps angle and increased posterior tibial slope may predispose girls and women to ACL injury. Compared with males, females have smaller notch widths and smaller ACL cross-sectional area; however, no conclusive correlation between ACL size and notch dimension exists, especially in relation to risk of ACL injury. Female athletes who land with the knees in inadequate flexion and in greater-than-normal valgus and external rotation are at increased risk of ACL injury. No conclusive link has been made between ACL injury and the menstrual cycle. Neuromuscular intervention protocols have been shown to reduce the rate of injury in girls and women. Females are more likely than males to have a narrow A-shaped intercondylar notch, and special surgical considerations are required in such cases. Following ACL reconstruction, female athletes are more likely than male athletes to rupture the contralateral ACL; however, males and females are equally likely to rupture the reconstructed knee. Although self-reported outcomes in the first 2 years following reconstruction are worse for females than for males, longer-term studies demonstrate no difference between males and females. PMID:23281470

Sutton, Karen M; Bullock, James Montgomery

2013-01-01

180

Treating Anterior Cruciate Ligament Tears in Skeletally Immature Patients  

PubMed Central

Purpose To systematically review the current evidence for conservative and surgical treatment of anterior cruciate ligament (ACL) tears in skeletally immature patients. Methods A systematic search of PubMed, CINAHL, EMBASE, CCTR, and CDSR was performed for surgical and/or conservative treatment of complete ACL tears in immature individuals. Studies with less than six months of follow-up were excluded. Study quality was assessed and data were collected on clinical outcome, growth disturbance, and secondary joint damage. Results We identified 48 studies meeting the inclusion criteria. Conservative treatment was found to result in poor clinical outcomes and a high incidence of secondary defects, including meniscal and cartilage injury. Surgical treatment had only very weak evidence for growth disturbance, yet strong evidence of good postoperative stability and function. No specific surgical treatment showed clearly superior outcomes, yet the studies using physeal-sparing techniques had no reported growth disturbances at all. Conclusions The current best evidence suggests that surgical stabilization should be considered the preferred treatment in immature patients with complete ACL tears. While physeal-sparing techniques are not associated with a risk of growth disturbance, transphyseal reconstruction is an alternative with a beneficial safety profile and a minimal risk of growth disturbance. Conservative treatment commonly leads to meniscal damage and cartilage destruction and should be considered a last resort. Level of Evidence Level IV, systematic review of Level II, III, and IV studies.

Vavken, Patrick; Murray, Martha M

2011-01-01

181

"Biological failure" of the anterior cruciate ligament graft.  

PubMed

Anterior cruciate ligament (ACL) reconstruction has the best chance for success when the graft undergoes extensive biologic remodeling and incorporation after implantation. There are many factors that can lead to graft failure and possible revision surgery. These include patient selection; surgical technique such as graft placement and tensioning; the use of allograft versus autograft; mechanical factors such as secondary restraint laxity; lack of a correct, carefully controlled post-operative rehabilitation program; and biological factors. When a patient presents with knee instability following ligament reconstruction and there is no history of a new trauma or identifiable technical error, biological failure should be considered. However, the biologic response of the grafted tissue is closely linked to the mechanical and biochemical environment into which the graft is placed. Thus, the "biological failure" of the ACL graft is a complex pathological entity whose cause is not fully understood. Failure may be initiated by early extensive graft necrosis, disturbances in revascularization, problems in cell repopulation and proliferation, and as well difficulties in the ligamentization process. However, further study of the biological characterization of a failed graft placed in a correct mechanical environment is warranted. PMID:18183368

Ménétrey, J; Duthon, V B; Laumonier, T; Fritschy, D

2008-01-09

182

Anatomic double-bundle anterior cruciate ligament reconstruction.  

PubMed

Several double-bundle anterior cruciate ligament (ACL) reconstruction procedures were reported in the 1980s and 1990s. However, no significant differences were found in the clinical results between these double-bundle procedures and single-bundle procedures because the double-bundle procedures appeared to reconstruct only the anteromedial bundle with 2 bundles. In the early 2000s, we proposed a new concept of anatomic reconstruction of the anteromedial and posterolateral bundles, in which 4 independent tunnels were created through the center of each anatomic attachment of the 2 bundles. We called it "anatomic" double-bundle ACL reconstruction. Biomechanical studies have shown that the anatomic double-bundle ACL reconstruction can restore knee stability significantly more closely to the normal level than the conventional single-bundle reconstruction. Recent intraoperative measurement studies have shown that the clinically available anatomic double-bundle procedures can reconstruct knee stability significantly better and improve knee function close to the normal level at the time immediately after surgery compared with the conventional single-bundle procedures. However, the greatest criticism of the anatomic double-bundle reconstruction is whether its clinical results are better than the results of single-bundle reconstruction. To date (January 2010), 10 prospective comparative clinical trials (Level I or II) and 1 meta-analysis have been reported comparing single-bundle and anatomic double-bundle reconstructions using hamstring tendons. In 8 of the 10 studies, the anterior and/or rotatory stability of the knee was significantly better with the anatomic double-bundle ACL reconstruction than with the conventional single-bundle reconstruction. However, 1 original trial and the meta-analysis found that there were no differences in the results between the 2 types of reconstructions. Thus the utility of the anatomic double-bundle reconstruction has not yet been established. Our review does show how much evidence exists as to the benefits of double-bundle ACL reconstruction at present. PMID:20810091

Yasuda, Kazunori; Tanabe, Yoshie; Kondo, Eiji; Kitamura, Nobuto; Tohyama, Harukazu

2010-09-01

183

The Function of the Human Anterior Cruciate Ligament and Analysis of Single- and Double-Bundle Graft Reconstructions  

PubMed Central

Context: There exists controversy on the ability of a single or double anterior cruciate ligament graft technique to restore anterior cruciate ligament function. This article examines the published experimental and clinical data supporting these surgical procedures in the ability to restore knee stability. Evidence Acquisition: An analysis of anterior cruciate ligament function and single- and double-graft reconstructions defined by selected biomechanical, robotic, kinematic, anatomical, and clinical studies. Results: The anterior cruciate ligament resists the combined motions of anterior tibial translation and internal tibial rotation, which defines the concept of rotational stability. This function prevents anterior tibial subluxation of the lateral and medial tibiofemoral compartments that accounts for the pivot-shift phenomena. The placement of single anterior cruciate ligament grafts high and proximal at the femoral attachment and posterior at the tibial attachment results in a vertical graft orientation. This graft placement results in a limited ability to provide rotational stability and is inferior when compared to a double-bundle graft procedure. Studies show that a more oblique single-graft orientation, in the sagittal and coronal plane, achieved from a central anatomic femoral and tibial location provides rotational stability similar to a double-bundle anterior cruciate ligament graft. Conclusion: There exists insufficient experimental and clinical data to recommend the more complex double-bundle anterior cruciate ligament graft technique over a well-placed central anatomic single graft in terms of restoring knee rotational stability. Meticulous surgical technique for anterior cruciate ligament graft placement is necessary to avoid failure.

2009-01-01

184

Effect of knee flexion on the in situ force distribution in the human anterior cruciate ligament  

Microsoft Academic Search

This study was conducted to evaluate the effect of applied load on the magnitude, direction, and point of tibial intersection of the in situ forces of the anteromedial (AM) and posterolateral (PL) bands of the human anterior cruciate ligament (ACL) at 30° and 90° of knee flexion. An Instron was used to apply a 100 N anterior shear force to

J. W. Xerogeanes; Y. Takeda; G. A. Livesay; Y. Ishibashi; H. S. Kim; F. H. Fu; S. L.-Y. Woo

1995-01-01

185

Review on tension in the natural and reconstructed anterior cruciate ligament  

Microsoft Academic Search

This article reviews the methodology and results of published studies concerned with tension in the natural and reconstructed anterior cruciate ligament (ACL). This also includes studies of fiber length changes with knee motion and the relationships between graft tunnel placements and isometricity. Little work has been done in vivo: in humans, length changes of the anterior ACL fibers have been

H. N. Andersen; A. A. Amis

1994-01-01

186

Estrogen level alters the failure load of the rabbit anterior cruciate ligament.  

PubMed

We hypothesized that increasing the level of circulating serum estrogen would decrease the load at failure for the rabbit anterior cruciate ligament. We developed an animal model in which hormonal manipulations could be correlated with load at failure for the anterior cruciate ligament. Sixteen New Zealand White ovariectomized rabbits were matched and divided into two groups. The eight rabbits that were not treated with the estrogen supplement (Group O) and the eight that were treated with the supplement (Group E) were housed for 30 days. Serum estrogen levels were measured. The knees were stripped of all soft tissue, and the load at failure for the anterior cruciate ligament was measured in a materials testing machine with a displacement rate of 0.5 mm/sec. The load at failure for all 16 specimens in Group E (446 +/- 54 N) (mean +/- SD) was significantly reduced (p = 0.02) compared with that for the nine specimens in Group O (503 +/- 48 N). It is recognized that an increased number of anterior cruciate ligament injuries occurs in female athletes. Although the mechanism responsible for failure of the anterior cruciate ligament in women is yet to be defined, this experiment suggests that estrogen may alter ligament strength. PMID:10376730

Slauterbeck, J; Clevenger, C; Lundberg, W; Burchfield, D M

1999-05-01

187

Transphyseal reconstruction of the anterior cruciate ligament in prepubescent athletes.  

PubMed

ACL reconstruction in adolescents undergoing or being beyond the final growth spurt can be performed as in adults without major concern of growth disturbance. Whereas for the young athlete with wide-open physis a lot of controversy still exists about the technical aspect of the procedure to minimise the risk of growth disturbance. Between 10/1997 and 10/2002 31 children graded Tanner stage 1 or 2 (median age 11 years) with an intraligamental rupture of the anterior cruciate ligament were enrolled. Seventeen patients with coexisting intraarticular damage (meniscus, osteochondral flake) underwent transphsyeal reconstruction of the ACL with the use of an autogenous semitendinosus tendon graft, whereas 14 patients without coexisting pathologies received a nonoperative regime. Growth disturbance, functional and radiographic outcome could be evaluated in 28 patients at a median of 70 months after initial treatment. No patient had clinical or radiological evidence for varus/valgus malalignment or leg length discrepancy. The mean of subsequent body growth within the study population was 20.3 cm. Patients operated on revealed significant (P < 0.05) better clinical (KT-1000 side-to-side difference, pivot shift) and functional results according to the IKDC (median, 95 vs. 87), Lysholm (median, 93 vs. 84) and the Tegner score. More than half of the conservatively treated patients (58%) had subsequent surgery due to persistent instability. Transphyseal reconstruction of intraligamental ACL ruptures with an autologous ST graft yielded superior clinical results if compared to a nonoperative treatment in immature prepubescent patients being Tanner stage 1 and 2. PMID:20130837

Streich, Nikolaus A; Barié, Alexander; Gotterbarm, Tobias; Keil, Maximilian; Schmitt, Holger

2010-02-04

188

Anterior Cruciate Ligament Injury Prevention Training in Female Athletes  

PubMed Central

Context: Many anterior cruciate ligament (ACL) injury prevention training programs have been published, but few have assessed the effects of training on both ACL injury rates and athletic performance tests. Objective: To determine if ACL injury prevention programs have a positive influence on both injury rates and athletic performance tests in female athletes. Data sources: In August 2011, a search was conducted (1995–August 2011) of the PubMed, Science Direct, and CINAHL databases. Study selection: Selected studies determined the effect of ACL intervention training programs on ACL incidence rates (determined by athlete-exposures) and athletic performance tests, such as isokinetic strength, vertical jump height, speed, agility, and dynamic balance. Because no single article contained both criteria, investigations were cross-referenced to obtain data on both factors from the same training programs. Data extraction: The authors reviewed the selected studies for cohort population numbers, age, sports, duration of study, program components, duration of training, number of athlete-exposures, ACL injury incidence rates, and results of athletic performance tests. Results: Initially, 57 studies were identified that described 42 ACL injury prevention training programs. Of these, 17 studies that investigated 5 programs met the inclusion criteria. Two programs significantly reduced ACL injury rates and improved athletic performance tests: Sportsmetrics and the Prevent Injury and Enhance Performance program (PEP). Sportsmetrics produced significant increases in lower extremity and abdominal strength, vertical jump height, estimated maximal aerobic power, speed, and agility. Prevent Injury and Enhance Performance significantly improved isokinetic knee flexion strength but did not improve vertical jump height, speed, or agility. The other 3 programs (Myklebust, the “11,” and Knee Ligament Injury Prevention) did not improve both ACL injury rates and athletic performance tests. Conclusions: Only the Sportsmetrics and PEP ACL intervention training programs had a positive influence on injury reduction and athletic performance tests.

Noyes, Frank R.; Barber Westin, Sue D.

2012-01-01

189

Gait analysis post anterior cruciate ligament reconstruction: knee osteoarthritis perspective.  

PubMed

Individuals with anterior cruciate ligament (ACL) reconstruction are at increased risk to develop knee osteoarthritis (OA). Gait analysis describing kinetics of the lower extremity during walking and stair use (stair ascent and stair descent) can provide insight to everyday dynamic knee joint loading. In this study, we compared lower extremity gait patterns of those with ACL reconstruction (>1 year) to a control group. Fifteen ACL reconstructed individuals and 17 healthy controls participated in this study. Knee extensor and flexor strength were assessed. Using inverse dynamics, lower extremity moments were calculated during the stance phase of walking and during two steps of stair ascent and descent. Univariate ANOVA was used to test for main effects between (1) injured leg and control group and (2) non-injured leg and control group. Student paired t-tests were used to determine differences between the injured and non-injured leg. Those with ACL reconstruction exhibited reduced initial knee flexion angles during stair descent, reduced knee extension moments during stair descent and stair ascent (second step), and increased hip extension moments during stair ascent (second step) and walking as compared to controls. Knee flexor strength was significantly reduced in the ACL group, but no differences were found in knee extensor strength. No kinematic or kinetic differences were observed between the injured and non-injured leg of the ACL group. Walking and stair ambulation highlight altered joint loading in those with ACL reconstruction surgery. Individuals appeared to compensate for lower knee extension moments by increasing hip extension moments. Furthermore, the load distribution on the articular cartilage is likely shifted as evidenced by reduced knee flexion angles in the ACL reconstructed leg. PMID:22310303

Hall, Michelle; Stevermer, Catherine A; Gillette, Jason C

2012-02-05

190

Effect of a functional knee brace on knee flexion and extension strength after anterior cruciate ligament reconstruction  

Microsoft Academic Search

Birmingham TB, Kramer JF, Kirkley A. Effect of a functional knee brace on knee flexion and extension strength after anterior cruciate ligament reconstruction. Arch Phys Med Rehabil 2002;83:1472-5. Objectives: To investigate the effect of a knee brace on knee flexion and extension muscular strength of patients after anterior cruciate ligament (ACL) reconstruction and to evaluate whether the effect of the

Trevor B. Birmingham; John F. Kramer; Alexandra Kirkley

2002-01-01

191

[Improvement of graft fixation methods for reconstruction of the anterior cruciate ligament].  

PubMed

In N. N. Priorov Institute of Traumatology and Orthopedics, atografts with bone blocks have been extensively used over the last 10 years to reconstruct anterior cruciate ligament after sports, ballet, and circus injuries. The autografts are fixed by interference screws at the level of the articular space. Reconstruction of the anterior cruciate ligament by this technique was performed in more than 800 patients (99%) between 1998 and 2006. Positive outcome was achieved in the majority of the cases (93%). A more universal method for the fixation of autografts with bone blocks has been employed since 2005 using polylactic acid pins, the Rigidfix system, and Milago interference screws. The Rigidfix system is most suitable for revisional reconstruction and may serve as an alternative tool for the primary reconstruction of the anterior cruciate ligament. PMID:19065738

Orletski?, A K; Timchenko, D O

2008-01-01

192

Influence of a monocentric knee brace on the tension of the collateral ligaments in knee joints after sectioning of the anterior cruciate ligament––an in vitro study  

Microsoft Academic Search

Objective. To analyze the influence of knee bracing on the tension of the medial and lateral collateral ligaments in anterior cruciate ligament deficiency.Design. The tension of the collateral ligaments in anterior cruciate ligament deficient knees was measured with and without knee bracing using an in vitro model.Background. Anterior cruciate ligament deficiency increases the tension in both collateral ligaments at the

S. Hinterwimmer; H. Graichen; R. Baumgart; W. Plitz

2004-01-01

193

Anterior Cruciate Ligament Injuries in Female AthletesPart 2, A Meta-analysis of Neuromuscular Interventions Aimed at Injury Prevention  

Microsoft Academic Search

Female athletes have a 4 to 6 times higher incidence of anterior cruciate ligament injury than do male athletes participating in the same landing and pivoting sports. This greater risk of anterior cruciate ligament injury, coupled with a geometric increase in participation (doubling each decade), has led to a significant rise in anterior cruciate ligament injuries in female athletes. The

Timothy E. Hewett; Kevin R. Ford; Gregory D. Myer

2006-01-01

194

Early radiographic features in patients with anterior cruciate ligament rupture  

PubMed Central

OBJECTIVE—To determine, in a preliminary cross sectional study of patients with anterior cruciate ligament (ACL) ruptured knees, which of the radiographic features—subchondral cortical plate thickness, trabecular sclerosis, and osteophytosis—appears before or in association with changes in joint space width (JSW) as a surrogate for articular cartilage thickness in patients with ruptured knees.?METHODS—19 patients (14 men), mean (95% CI) age 28.7 (23.6 to 33.8) years, had ACL rupture in one knee only, confirmed by arthroscopy. Anterior draw, Lachman's test, and pivot shift tests were performed and ×5 posteroanterior macroradiographs of both knees in a standing semiflexed view were taken at a mean (95% CI) time from injury of 34.3 (26.9 to 41.7) months. In each radiograph, computerised methods were used to measure minimum JSW and fractal signature analysis (FSA) to quantify the vertical and horizontal trabecular organisation, osteophyte area, and the subchondral cortical plate thickness, in the medial and lateral tibial compartments of all knees.?RESULTS—Physical examination confirmed the presence of joint laxity in the injured knees. No statistical difference in either medial or lateral JSW and subchondral cortical plate thickness was detected between ACL ruptured and uninjured knees. FSA showed a significant decrease in fractal dimension for the horizontal trabeculae (size 0.42 mm) in the medial compartment of the ACL ruptured knees compared with the uninjured knees (p<0.01, multivariate analysis of variance). There was an inverse correlation (R ?0.74) between the time since knee injury and the difference in FSA values for ACL ruptured and uninjured knees in medial compartment horizontal trabeculae (size 0.4 mm). No significant changes were detected in the lateral compartment. Osteophytes were detected in the medial compartment of nine ACL injured knees.?CONCLUSION—Compared with the uninjured knee, ACL rupture leads to thickening of subchondral horizontal trabeculae (decreased FSA) in the medial tibial compartment of all knees, reaching significance at about four years after injury. Osteophytes were present in the same compartment in 9/19 knees. No changes in JSW and subchondral cortical plate thickness were detected. Whether the bony changes detected in these ACL ruptured knees presage those of early osteoarthritis requires further study.??

Buckland-Wright, J; Lynch, J; Dave, B

2000-01-01

195

Systematic Review of Arthroscopic Versus Open Repair for Recurrent Anterior Shoulder Dislocations  

PubMed Central

Context: It remains unknown if arthroscopic repair of recurrent anterior shoulder instability is as effective as open repair. Objective: The purpose of this study is to analyze the literature to provide clinical recommendations regarding the most appropriate therapeutic intervention for recurrent anterior shoulder instability. Study Design: Systematic review of level I and II studies. Data Sources: PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and secondary references from 1967 to March 2010 were appraised for studies that met the inclusion criteria. Study Selection: Inclusion criteria were English-language level I or level II trials involving the treatment of recurrent anterior shoulder instability. Exclusion criteria included non-English-language studies; level III, IV, or V studies; and trials examining treatment of first-time shoulder dislocation, posterior shoulder dislocation, or diagnoses other than recurrent anterior shoulder dislocations. Data Extraction: Included studies underwent quality appraisal independently by each author identifying strengths, weaknesses, and biases. Results: Four randomized controlled trials compared the use of arthroscopic and open repair for recurrent anterior shoulder dislocations. These studies show no statistically significant difference between the 2 operative approaches. No long-term follow-up data describing the effects of either surgical approach are available at this time. Each investigation had weaknesses in study design that decreased the validity of its findings. Conclusions: While limited, the available evidence from randomized controlled trials does not show a statistically significant difference in redislocation rates, return to activity, and functional outcomes between the arthroscopic and open repair groups. Range of motion is marginally better following arthroscopic treatment when compared with open repair. Recommendations on the optimal surgical intervention cannot be provided.

Godin, Jonathan; Sekiya, Jon K.

2011-01-01

196

Intraarticular stabilization following anterior cruciate ligament injury in children and adolescents  

Microsoft Academic Search

Purpose  Significant controversy exists regarding the potential harm to the growth plate following reconstruction of the anterior cruciate\\u000a ligament in skeletally immature patients. This study was performed to evaluate the results of a transepiphyseal replacement\\u000a of the anterior cruciate ligament in skeletally immature patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Ninety-four skeletally immature patients (56 male and 38 female) with median age 13.7 years (range, 11.6–15.9 years) who underwent

Pantelis Nikolaou; Alkiviadis Kalliakmanis; Dimitrios Bousgas; Sarantos Zourntos

2011-01-01

197

Experimental and Numerical Analysis of Screw Fixation in Anterior Cruciate Ligament Reconstruction  

NASA Astrophysics Data System (ADS)

This paper reports the results of an experimental and finite element analysis of tibial screw fixation in anterior cruciate ligament (ACL) reconstruction. The mechanical properties of the bone and tendon graft are obtained from experiments using porcine bone and bovine tendon. The results of the numerical study are compared with those from mechanical testing. Analysis shows that the model may be used to establish the optimum placement of the tunnel in anterior cruciate ligament reconstruction by predicting mechanical parameters such as stress, strain and displacement at regions in the tunnel wall.

Chizari, Mahmoud; Wang, Bin; Snow, Martyn; Barrett, Mel

2008-09-01

198

Preparing a female collegiate athlete for anterior cruciate ligament reconstruction and rehabilitation.  

PubMed

An anterior cruciate ligament injury is common among athletes involved in sports where cutting or sudden changes of position occur. This is a case study of a female collegiate athlete who sustained an anterior cruciate ligament injury, with a small meniscus tear, and decides on a course of surgery. Questions she has about the initial injury, as well as subsequent questions concerning reconstructive surgery using a patellar graft and the course of rehabilitation, are answered. A chart of her rehabilitation protocol is provided. PMID:12803146

Leech, Edward

199

Combined rupture of the patellar tendon, anterior cruciate ligament and lateral  

PubMed Central

Simultaneous rupture of both the patellar tendon and the anterior cruciate ligament is a relatively rare injury. Its diagnosis can easily be missed during the initial examination. Treatment options include immediate repair of the patellar tendon with either simultaneous or delayed reconstruction of the ACL. We present the case of a combined rupture of the patellar tendon, the anterior cruciate ligament and the lateral meniscus in a 38-year old recreational martial arts athlete after a direct kick on his left knee. A two-stage treatment approach was performed with an excellent functional outcome.

Tsarouhas, A; Iosifidis, M; Kotzamitelos, D; Traios, S

2011-01-01

200

A new diagnostic approach using regional analysis of anterior knee laxity in patients with anterior cruciate ligament deficiency  

Microsoft Academic Search

Purpose  The first purpose of this study was to analyze the characteristics of the anterior knee laxity in the three regions of different\\u000a stiffness in the force–displacement curve, which was obtained from a frequently used arthrometer for quantifying knee joint\\u000a stability in the patients with anterior cruciate ligament (ACL) rupture and the healthy controls. The second purpose was to\\u000a compare the

Hsiu-Chen Lin; Chia-Ming Chang; Horng-Chaung Hsu; Weng-Hang Lai; Tung-Wu Lu

2011-01-01

201

Outcome of Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review  

PubMed Central

Background: Revision anterior cruciate ligament (ACL) reconstruction is believed to have an inferior outcome compared with primary ACL reconstruction. The available literature on the outcome of revision ACL reconstruction is sparse compared with that for primary reconstruction. The purpose of this systematic review was to test the hypothesis that the outcome of revision ACL reconstruction compares unfavorably with the historical outcome of primary ACL reconstruction. Methods: A systematic review of studies evaluating the outcome of revision ACL reconstructions with a minimum of two years of follow-up was performed. Pooled data were collected when appropriate and a mixed-effect-model meta-analysis was performed for important outcome measures that were reported in several studies (objective graft failure, Lysholm score, International Knee Documentation Committee [IKDC] subjective score, and IKDC objective score). Objective failure was defined as repeat revision, a side-to-side difference of >5 mm measured with use of a KT1000 arthrometer, or a pivot-shift grade of 2+ or 3+. Results: Twenty-one studies were included, and 863 of the 1004 patients in these studies had a minimum of two years of follow-up and were analyzed. The pooled mean age of the patients at the time of the revision procedure was 30.6 years, and 66% were male. Objective failure occurred in 13.7% ± 2.7% of the patients (95% confidence interval, 8.0% to 19.4%). The mean Lysholm score in 491 patients was 82.1 ± 3.3 (95% confidence interval, 74.6 to 89.5) according to a mixed-model meta-analysis. The mean IKDC subjective score in 202 patients was 74.8 ± 4.4 (95% confidence interval, 62.5 to 87.0). Conclusions: Revision ACL reconstruction resulted in a worse outcome compared with primary ACL reconstruction. Patient-reported outcome scores were inferior to previously published results of primary ACL reconstruction, but these differences may not be clinically important. A dramatically elevated failure rate was noted after revision ACL reconstruction; this rate was nearly three to four times the failure rate in prospective series of primary ACL reconstructions.

Wright, Rick W.; Gill, Corey S.; Chen, Ling; Brophy, Robert H.; Matava, Matthew J.; Smith, Matthew V.; Mall, Nathan A.

2012-01-01

202

Prospective Comparative Study of Anterior Cruciate Ligament Reconstruction Using the Double-Bundle and Single-Bundle Techniques  

PubMed Central

Background The intent of double-bundle anterior cruciate ligament reconstruction is to reproduce the normal anterior cruciate ligament anatomy and improve knee joint rotational stability. However, no consensus has been reached on the advantages of this technique over the single-bundle technique. Hypothesis We hypothesized that double-bundle anterior cruciate ligament reconstruction could provide better intraoperative stability and clinical outcome than single-bundle reconstruction. Type of study Cohort study; Level of evidence, 2. Methods Forty patients with anterior cruciate ligament injury in one knee were recruited; 20 were allocated to a double-bundle anterior cruciate ligament reconstruction group and 20 to a single-bundle anterior cruciate ligament reconstruction group. Intraoperative stabilities at 30° of knee flexion were compared between the 2 groups using a navigation system. Clinical outcomes including Lysholm knee scores, Tegner activity scores, Lachman and pivot-shift test results, and radiographic stabilities were also compared between the 2 groups after a minimum of 2 years of follow-up. Results Intraoperative anterior and rotational stabilities after anterior cruciate ligament reconstruction in the double-bundle group were significantly better than those in single-bundle group (P = .020 and P < .001, respectively). Nineteen patients (95%) in each group were available at a minimum 2-year follow-up. Clinical outcomes including Lysholm knee and Tegner activity scores were similar in the 2 groups at 2-year follow-up (P > .05). Furthermore, stability results of the Lachman and pivot-shift tests, and radiologic findings at 2-year follow-up failed to reveal any significant intergroup differences (P > .05). Conclusion Although double-bundle anterior cruciate ligament reconstruction produces better intraoperative stabilities than single-bundle anterior cruciate ligament reconstruction, the 2 modalities were found to be similar in terms of clinical outcomes and postoperative stabilities after a minimum of 2 years of follow-up.

Song, Eun Kyoo; Oh, Luke S.; Gill, Thomas J.; Li, Guoan; Gadikota, Hemanth R.; Seon, Jong Keun

2013-01-01

203

Meniscus repair in the anterior cruciate deficient knee  

Microsoft Academic Search

From 1979 to 1986, isolated repair of a peripheral vascular zone meniscal tear was performed in 22 pa tients (23 menisci) who had ACL insufficiency. For various reasons none of these patients underwent re pair or reconstruction of their ACL. The meniscus repair was done by open arthrotomy in 12 cases and by arthroscopic techniques in 11 cases. The purpose

Gregory A. Hanks; Trenton M. Gause; John A. Handal; Alexander Kalenak

1990-01-01

204

Telemetry system for monitoring anterior cruciate ligament graft forces in vivo  

Microsoft Academic Search

Quantifying changes in the tension of an anterior cruciate ligament (ACL) graft in vivo during rehabilitative exercises is vital for developing the optimal rehabilitation for patients who have had reconstructive surgery. The purpose of this project was to design, built, and test a telemetry system that can measure the in vivo ACL graft tension postoperatively. A commercially available fixation device

Eric L. McKee; Maury L. Hull; Stephen M. Howell

1997-01-01

205

Graft isometricity in unitunnel anterior cruciate ligament reconstruction: analysis of influential factors using a radiographic model  

Microsoft Academic Search

A radiographic model was developed to investigate the influence of three surgical variables on the change in attachment point distance (CAPD) of a hypothetical graft using the unitunnel technique of anterior cruciate ligament (ACL) reconstruction. Using three different femoral target points, we tested the hypothesis that varying the angle of knee flexion between 70° and 110° and varying the tibial

J. A. Feller; R. R. Glisson; A. V. Seaber; J. A. Feagin; W. E. Garrett

1993-01-01

206

Femoral Intercondylar Notch Stenosis and Correlation to Anterior Cruciate Ligament InjuriesA Prospective Study  

Microsoft Academic Search

To evaluate the possible relationship between femoral intercondylar notch stenosis and anterior cruciate liga ment injuries in pivoting and cutting sports, a 2-year prospective study was performed on intercollegiate ath letes at a Division I university. Daily practice times and athlete participation in practices and games were re corded for each sport during the 2-year period. Bilateral intercondylar notch view

Robert F. LaPrade; Quinter M. Burnett

1994-01-01

207

Failure of Reconstruction of the Anterior Cruciate Ligament Due to Impingement by the Intercondylar Roof  

Microsoft Academic Search

The relationship between impingement of the roof of the intercondylar notch on a reconstructed anterior cruciate ligament, and the subsequent stability and range of extension of the joint, was analyzed in forty- seven knees. The extent of the impingement was deter- mined by analysis of the relationship of the tibial tunnel to the intersection of the line of slope of

MAJOR STEPHEN M. HOWELL; CAPTAIN MICHAEL A. TAYLOR

208

The efficacy of continuous bupivacaine infiltration following anterior cruciate ligament reconstruction  

Microsoft Academic Search

Purpose: The purpose of this study was to determine whether continuous infiltration of a local anesthetic into the surgical wound for 48 hours will diminish the need for narcotics and improve the postoperative pain experience for patients undergoing anterior cruciate ligament (ACL) reconstruction using a patellar tendon autograft. Type of Study: Prospective, randomized, double-blind study with a placebo and an

Heinz R. Hoenecke; Pamela A. Pulido; Beverly A. Morris; Jan Fronek

2002-01-01

209

Anterior cruciate ligament strain in-vivo: A review of previous work  

Microsoft Academic Search

Disruption of the anterior cruciate ligament (ACL), a primary stabilizer of the knee, can produce disability. The purpose of our work has been to study the normal ACL in humans, in the presence of normal muscle function and body weight, and develop clinical criteria for reconstruction, establish a basis for rehabilitation programs, and evaluate how knee braces protect this important

Bruce D Beynnon; Braden C Fleming

1998-01-01

210

Chemically processed patellar tendon allografts for ovine anterior cruciate ligament reconstruction  

Microsoft Academic Search

A study was initiated to mechanically and histologically examine chemically processed patellar tendon allografts in sheep anterior cruciate ligament (ACL) repairs. One group of animals received frozen grafts that were processed with a chloroform\\/methanol solvent extraction technique, and a third sheep group received frozen tendons treated with a permeation enhanced extraction technique. Histologic analysis after two months of implantation revealed

J. Contiliano; M. C. Zimmerman; J. Billotti; T. Mango; J. R. Parsons; A. Prewett

1992-01-01

211

Simultaneous Acute Rupture of the Patellar Tendon and the Anterior Cruciate Ligament  

Microsoft Academic Search

We present 3 cases of simultaneous rupture of the patellar tendon and the anterior cruciate ligament (ACL) and discuss the diagnosis and treatment of this infrequent association. Between 1997 and 2000, 3 patients with a mean age of 37 years were treated with an ACL reconstruction and repair of the patellar tendon. The average follow-up was 3 years. Two of

Matias Costa-Paz; D. Luis Muscolo; Arturo Makino; Miguel A. Ayerza

2005-01-01

212

Biocompatibility of polyethylene terephthalate (Trevira ® hochfest) augmentation device in repair of the anterior cruciate ligament  

Microsoft Academic Search

The biocompatibility of a 3mm band made of polyethylene terephthalate (Trevira® hochfest) has been tested in an experimental study within right knee joints of 60 sheep. After transsecting the anterior cruciate ligament (ACL), two randomized groups were formed. In group I, the ACL was repaired according to the Marshall technique whilst in group II an additional 3mm polyethylene terephthalate (PET)

Helmut Seitz; Stefan Marlovits; Ilse Schwendenwein; Elisabeth Müller; Vilmos Vécsei

1998-01-01

213

Tunnel placement in anterior cruciate ligament (ACL) reconstruction: quality control in a teaching hospital  

Microsoft Academic Search

Correct placement of the femoral and tibial bone tunnels is decisive for a successful anterior cruciate ligament (ACL) reconstruction. Our method of tunnel placement was evaluated as part of quality control at a teaching hospital. The emphasis was placed mainly on investigating the influence of surgical experience on tunnel placement, and the effect of tunnel position on the clinical outcome.

H. Behrend; G. Stutz; M. A. Kessler; A. Rukavina; K. Giesinger; M. S. Kuster

2006-01-01

214

Anatomical considerations in hamstring tendon harvesting for anterior cruciate ligament reconstruction  

PubMed Central

Summary Hamstring tendons are widely used for anterior cruciate ligament (ACL) reconstruction of the knee. Certain anatomical considerations must be taken into account when harvesting the hamstring tendons to be used in ACL reconstruction. These anatomical considerations are discussed in this review article.

Charalambous, Charalambos Panayiotou; Kwaees, Tariq Adam

2012-01-01

215

Operative or conservative treatment of the acutely torn anterior cruciate ligament in middle-aged patients  

Microsoft Academic Search

In all, 133 patients with an acute rupture of the anterior cruciate ligament (ACL) were reviewed (aged ¶40 to 59 years). Average follow-up was 29 - 10 months. Thirty-one patients underwent conservative therapy, 35 patients were treated by primary suture, while in 67 the primary suture was augmented with the semitendinosus tendon. The patients with primary repair and semitendinosus tendon

S. P. Zysk; H. J. Refior

2000-01-01

216

Repair and reconstruction of the anterior cruciate ligament by the “Sandwich technique”  

Microsoft Academic Search

The effect of complete ensheathment of the repaired or reconstructed anterior cruciate ligament (ACL) in the infrapatellar fat pad was studied in a rabbit model. Four to 16 weeks after repair of a transected ACL or insertion of an autologous tendon graft these tissues were evaluated by histology and microangiography. Following ACL repair a high incidence of ligament atrophy was

M. W. Hoffmann; J. V. Wening; R. Apel; K.-H. Jungbluth

1993-01-01

217

Vitamin E and C supplementation does not ameliorate muscle dysfunction after anterior cruciate ligament surgery  

Microsoft Academic Search

Muscle atrophy and weakness are predominant impairments after anterior cruciate ligament (ACL) surgical repair. We tested the hypothesis that vitamin E and C supplementation will improve recovery from ACL injury. Men undergoing elective ACL surgery were randomly assigned to twice-daily supplements of either antioxidants (AO; vitamins E and C, n=10) or matching placebos (n=10) from 2 weeks before until 3

Tyler Barker; Scott W. Leonard; Janet Hansen; Roy H. Trawick; Ronda Ingram; Graham Burdett; Katherine M. Lebold; James A. Walker; Maret G. Traber

2009-01-01

218

Anterior Cruciate Ligament Reconstruction With a Quadrupled Hamstring Autograft Does Not Restore Tibial Rotation  

Microsoft Academic Search

Summary: As a result of the morbidity associated with anterior cruciate ligament (ACL) reconstruction with a bone-patellar-tendon-bone graft, many orthopaedic surgeons prefer hamstrings as the graft for ACL reconstruction. However, this selection is not based on solid scientific evidence. In vitro research shows that this graft cannot restore control of tibial rotation. Our recent in vivo research work has also

Anastasios D. Georgoulis; Stavros Ristanis; Vasilis Chouliaras; Constantina Moraiti; Nick Stergiou

2005-01-01

219

MR Imaging of the Anterior Cruciate Ligament: Value of Thin Slice Direct Oblique Coronal Technique  

Microsoft Academic Search

Purpose: The value of the thin slice direct oblique coronal technique, which is parallel to the anterior cruciate ligament (ACL), was assessed in the evaluation of ACL injury in comparison with conventional oblique sagittal and coronal images. Material and Methods: A thin slice direct oblique coronal technique was developed and applied clinically to 62 patients after conventional oblique sagittal and

Kazuhiro Katahira; Yasuyuki Yamashita; Mutsumasa Takahashi; Nobuko Otsuka; Yukunori Koga; Tetsuya Fukumoto; Kazutoshi Nomura

220

Assessment and Augmentation of Symptomatic Anteromedial or Posterolateral Bundle Tears of the Anterior Cruciate Ligament  

Microsoft Academic Search

The anterior cruciate ligament (ACL) consists of 2 anatomic and functional bundles, the anteromedial (AM) and posterolateral (PL) bundle. Depending on the mechanism of injury, there are different injury patterns to the AM and PL bundles, demonstrating a wide spectrum of partial ACL tears. Clinical interest has recently focused on establishing pre- and intraoperative ways of assessing the different types

Rainer Siebold; Freddie H. Fu

2008-01-01

221

A comparison of acute anterior cruciate ligament examinationsInitial versus examination under anesthesia  

Microsoft Academic Search

The preoperative examination, the examination under anesthesia, and the findings at surgery were compared for acutely injured knees that were found at surgery to have anterior cruciate ligament (ACL) tears.The pivot shift was initially positive in only 35% of the knees; however, under anesthesia 98% were pos itive. The Lachman test was initially positive in 99% of the knees, and

William F. Donaldson; Russell F. Warren; Thomas Wickiewicz

1985-01-01

222

The intercondylar notch in acute tears of the anterior cruciate ligament: A computer graphics study  

Microsoft Academic Search

Although the intercondylar notch becomes narrowed with a failed repair of the ACL or with chronic instability of the knee, narrowed intercondylar notches have fre quently been observed during arthrotomy for an acute ACL tear in previously uninjured knees. In order to determine whether the structure of the intercondylar notch predisposes a knee to anterior cruciate tears, a computer graphics

Stephen W. Houseworth; Vincent J. Mauro; Barbara A. Mellon; David A. Kieffer

1987-01-01

223

Using MR Imaging to Diagnose Partial Tears of the Anterior Cruciate Ligament: Value of Axial Images  

Microsoft Academic Search

OBJECTIVE. The purpose of this study was to determine the usefulness of axial MR imag- ing for diagnosing partial anterior cruciate ligament (ACL) tears and to detemiine if patients could be categorized as having stable or unstable partial ACL tears on the basis of criteria of ax- ial MR imaging. MATERIALS AND METHODS. We reviewed 238 patients who. over a

Sudipta Roychowdhury; Steven W. Fitzgerald; Andrew H. Sonin; Anthony J. Peduto; Frank H. Miller; Frederick L. Hoff

224

Electromyographic analysis of muscle fatigue in anterior cruciate ligament deficient knees.  

PubMed

The aim of this study was to detect possible differences in muscle fatigue and recovery of knee flexor and extensor muscles in patients with a deficient anterior cruciate ligament compared with patients with a normal anterior cruciate ligament. Surface electromyography of 15 patients with anterior cruciate ligament deficiency was performed while the muscles were under 80% of maximum isometric contraction, and after 1, 2, 3, and 5 minutes of rest. During the first 60 seconds of contraction, all muscles recorded significantly decreased mean power frequency and increased amplitude. The rate of decrease of mean power frequency was significantly greater in the injured quadriceps and normal hamstrings. All muscles except two recovered to the initial mean power frequency level after 1 minute of rest. All but two muscles in the injured and normal limb recorded an overshoot of mean power frequency during the recovery phase. This overshoot phenomenon also was seen for some muscles in the amplitude analysis. The findings confirm the fatigue state in all the muscles, suggest recruitment of more Type II fibers as the muscle fatigues, and show the physiologic adaptation of the quadriceps and hamstrings to anterior cruciate ligament insufficiency. The current study indirectly shows a dissociation between low intramuscular pH and mean power frequency during the recovery phase. It also indirectly suggests that the atrophied thigh muscles have fiber type composition similar to that of the normal side. PMID:9224249

Tho, K S; Németh, G; Lamontagne, M; Eriksson, E

1997-07-01

225

Level of Evidence in Anterior Cruciate Ligament Reconstruction Research: A Systematic Review  

Microsoft Academic Search

BACKGROUND:There have been numerous studies on anterior cruciate ligament (ACL) reconstruction. Considering the vast number of studies, a quick assessment reveals rather few with a high level of evidence. PURPOSE:The primary aim was to categorize the study type and level of evidence of studies on primary ACL reconstruction by applying the level of evidence rating system proposed by the Oxford

K. Samuelsson; N. Desai; E. McNair; C. F. van Eck; M. Petzold; F. H. Fu; M. Bhandari; J. Karlsson

2012-01-01

226

Identification of Athletes at Future Risk of Anterior Cruciate Ligament Ruptures by Neuromuscular Screening  

Microsoft Academic Search

Background: A high percentage of female athletes who sustain an anterior cruciate ligament (ACL) rupture suffer serious long-term consequences such as osteoarthritis and disability. Thus, identification of risk factors has high clinical relevance in the prevention of ACL rupture.Hypothesis: Noninjured athletes with low knee flexor electromyography (EMG) preactivity and high knee extensor EMG preactivity during sidecutting are at increased risk

Mette K. Zebis; Lars L. Andersen; Jesper Bencke; Michael Kjær; Per Aagaard

2009-01-01

227

SKELETAL KINEMATICS OF THE ANTERIOR CRUCIATE LIGAMENT DEFICIENT KNEE WITH AND WITHOUT FUNCTIONAL BRACES  

Microsoft Academic Search

Steinmann traction pins were implanted into the femur and tibia of six subjects having a partial or complete anterior cruciate ligament (ACL) rupture. Patients jumped for maximal horizontal distance and landed onto their deficient limb with the knee braced and unbraced. Tibiofemoral rotations and translations showed a general trend across subjects, i.e. skeletally based curves were similar in shape and

Dan K. Ramsey; Mario Lamontagne; Per F. Wretenberg; Gunnar Németh

228

Anterior Cruciate Ligament Injury Incidence Among Male and Female Professional Alpine Skiers  

Microsoft Academic Search

A retrospective review of anterior cruciate ligament injuries among professional alpine skiers was performed to compare sex-related differences in injury incidence. We screened 7155 ski patrollers or instructors (4537 men and 2618 women) for knee injuries before each ski season between 1991 and 1997. Screening involved a ski history questionnaire, a knee injury history questionnaire, and a knee physical examination.

Randall W. Viola; J. Richard Steadman; Scott D. Mair; Karen K. Briggs; William I. Sterett

1999-01-01

229

Anterior cruciate ligament reconstruction using hamstring tendon graft without detachment of the tibial insertion  

Microsoft Academic Search

Introduction: We report results of the anterior cruciate ligament reconstruction using a four-strand hamstring graft without detachment of the tibial insertion of the tendons. Material and Methods: In 74 patients the hamstring graft was fixed using an endobutton on the femoral side and a barbed staple on the tibial side. There were 69 male and 5 female patients. The mean

M. Salman Ali; A. Kumar; S. Adnaan Ali; T. Hislop

2006-01-01

230

Training for Women's Basketball: A Biomechanical Emphasis for Preventing Anterior Cruciate Ligament Injury.  

ERIC Educational Resources Information Center

Summarizes proposed variables linked with higher incidences of anterior cruciate ligament tears in females and the biomechanical aspects of the lower extremity during the performance of common basketball skills, focusing on gender differences in knee joint stability and neuromuscular control, biomechanical aspects of lower extremity skills in…

Pettitt, Robert W.; Bryson, Erin R.

2002-01-01

231

Training for Women's Basketball: A Biomechanical Emphasis for Preventing Anterior Cruciate Ligament Injury.  

ERIC Educational Resources Information Center

|Summarizes proposed variables linked with higher incidences of anterior cruciate ligament tears in females and the biomechanical aspects of the lower extremity during the performance of common basketball skills, focusing on gender differences in knee joint stability and neuromuscular control, biomechanical aspects of lower extremity skills in…

Pettitt, Robert W.; Bryson, Erin R.

2002-01-01

232

Tibial Tunnel Placement in Anterior Cruciate Ligament Reconstructions and Graft Impingement  

Microsoft Academic Search

Fifty-six anterior cruciate ligament (ACL) reconstructions had a magnetic resonance scan of the ACL graft six months after operation. The impingement-free grafts (n = 26) had a low mag- netic resonance signal from origin to insertion. Impinged grafts (n = 30) had an increased mag- netic resonance signal confined to the distal two thirds of the graft. The location of

MAJ STEPHEN M. HOWELL; JAMES A. CLARK

1992-01-01

233

The natural history of meniscal tears in anterior cruciate ligament insufficiency  

Microsoft Academic Search

We reviewed the meniscal status of 176 consecutive patients undergoing anterior cruciate ligament recon struction acutely (less than 6 weeks from injury), sub- chronically (6 weeks to 12 months from injury), and chronically (more than 12 months from injury). The commonest tear was the single longitudinal vertical split of the medial meniscus. There was an increasing inci dence of meniscal

Gregory C. R. Keene; Derek Bickerstaff; Paul J. Rae; Roger S. Paterson

1993-01-01

234

The effect of different graft tensioning in anterior cruciate ligament reconstruction: A prospective randomized study  

Microsoft Academic Search

A prospective study was performed to establish the influence on stability of tensioning the graft after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft. There were 38 consecutive patients randomly divided into two groups; in the first group (19 patients) the graft was tensioned at 20 N, and in the second group the tension was 40 N. Evaluation included

A van Kampen

1998-01-01

235

Return to Play After Anterior Cruciate Ligament Reconstruction in National Football League Athletes  

Microsoft Academic Search

Background: Rupture of the anterior cruciate ligament (ACL) is a common and potentially career-threatening injury in the National Football League (NFL). The return to play (RTP) percentage and the factors affecting RTP after ACL reconstruction in NFL players are not well defined.Purpose: To determine the actual rate of return to professional football play in the NFL after ACL reconstruction surgery

Vishal M. Shah; James R. Andrews; Glenn S. Fleisig; Christopher S. McMichael; Lawrence J. Lemak

2010-01-01

236

Anatomic Single and Double-Bundle Anterior Cruciate Ligament Reconstruction Flowchart  

Microsoft Academic Search

Anatomy is the foundation of orthopaedic surgery, and the advancing knowledge of the anterior cruciate ligament (ACL) anatomy has led to the development of improved modern reconstruction techniques that approach the anatomy of the native ACL. Current literature on the anatomy of the ACL and its reconstruction techniques, as well as our surgical experience, was used to develop a flowchart

Carola F. van Eck; Bryson P. Lesniak; Verena M. Schreiber; Freddie H. Fu

2010-01-01

237

Cyclops syndrome occurring after partial rupture of the anterior cruciate ligament not treated by surgical reconstruction  

Microsoft Academic Search

Cyclops syndrome is one of the specific causes of loss of extension of the knee following anterior cruciate ligament (ACL) reconstruction. The syndrome is manifested by progressive loss of extension associated with pain and audible clunk at terminal extension caused by a pedunculated nodule of fibrovascular proliferative tissue usually arising from the graft. The entity has been described recently and

Matjaz Veselko; Aleksander Rotter; Martin Tonin

2000-01-01

238

The Cyclops Lesion: A Cause of Diminished Knee Extension After Rupture of the Anterior Cruciate Ligament  

Microsoft Academic Search

Summary: Four patients presented with persistent diminution of knee motion after rupture of the anterior cruciate ligament with a novel lesion as the cause. Each had participated in an aggressive rehabilitation program for a minimum of 2 months with emphasis on regaining full range of knee motion. Because chronic impairment of knee extension can be disabling, in those who did

Patrick J. McMahon; James R. Dettling; Lewis A. Yocum; Ronald E. Glousman

1999-01-01

239

Electromyographic Activity in Expert Downhill Skiers Using Functional Knee Braces After Anterior Cruciate Ligament Injuries  

Microsoft Academic Search

We studied six expert downhill skiers who had sus tained anterior cruciate ligament injuries and had dif ferent degrees of knee instability. The aim was to measure possible changes in electromyographic activ ity recorded from lower extremity muscles during downhill skiing in a slalom course without and with a custom-made brace applied to the injured knee. Sur face electrodes were

Gunnar Németh; Mario Lamontagne; Kam San Tho; Ejnar Eriksson

1997-01-01

240

Rehabilitation Following Anterior Cruciate Ligament Injury Current Recommendations for Sports Participation  

Microsoft Academic Search

treatment after rupture of the anterior cruciate ligament (ACL) may be operative or conservative. In both cases, the goal is to reach the best functional level for the patient without risking new injuries or degenerative changes in the knee. Return to high level of athletic activity has been an indicator of treatment success. Rehabili- tation is an important part of

Joanna Kvist

241

Development of Robotic Assistive Surgery System for Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Reconstruction surgery for an Anterior Cruciate Ligament (ACL) is becoming increasingly popular, due to the increase in people engaging in sport. In this surgery, four bone tunnels are drilled in the femur and tibia respectively, following which two substitute ligaments extracted from the other part of body, so called grafts, are inserted and fixed to both bones. However, although this

Masahiro Hirabayashi; Nobuaki Hayashi; Jun Okamoto; Masakatsu G. Fujie; Hirotsugu Muratsu; Masahiro Kurosaka

2006-01-01

242

Anatomical considerations in hamstring tendon harvesting for anterior cruciate ligament reconstruction.  

PubMed

Hamstring tendons are widely used for anterior cruciate ligament (ACL) reconstruction of the knee. Certain anatomical considerations must be taken into account when harvesting the hamstring tendons to be used in ACL reconstruction. These anatomical considerations are discussed in this review article. PMID:23738306

Charalambous, Charalambos Panayiotou; Kwaees, Tariq Adam

2013-01-21

243

Corticomotor excitability associated with unilateral knee dysfunction secondary to anterior cruciate ligament injury  

Microsoft Academic Search

In the present report, we investigated changes in corticomotor excitability associated with unilateral knee dysfunction secondary to anterior cruciate ligament (ACL) injury. Ten participants, each with a previous history of unilateral ACL injury (median time post-injury 22 months) and eight healthy controls underwent transcranial magnetic stimulation (TMS) to assess excitability of the lower limb motor representation. Resting motor thresholds (RMTs) and

Martin E. Héroux; François Tremblay

2006-01-01

244

Anterior cruciate ligament repairs in world class skiers  

Microsoft Academic Search

From 1979 to 1984, 27 skiers who were either present or past members of the United States Ski Team or professional skiers had 30 ACL tears that were repaired primarily. Only two of the repairs were augmented with autogenous patellar tendon grafts. Five patients had complete knee dislocations, including tears of both cruciate ligaments. Nineteen patients had a concomi tant

R. W. Higgins; J. R. Steadman

1987-01-01

245

Electromyographic and biomechanic analysis of anterior cruciate ligament deficiency and functional knee bracing  

Microsoft Academic Search

Objective. Examine the neuromuscular response to functional knee bracing relative to anterior tibial translations in vivo.Design. During randomised brace conditions, electromyographic data with simultaneous skeletal tibiofemoral kinematics were recorded from four anterior cruciate ligament deficient subjects to investigate the effect of the DonJoy Legend functional brace during activity.Background. Knee braces do not increase knee stability but may influence afferent inputs

Dan K Ramsey; Per F Wretenberg; Mario Lamontagne; Gunnar Németh

2003-01-01

246

Different aspects of the cyclops lesion following anterior cruciate ligament reconstruction: A multifactorial etiopathogenesis  

Microsoft Academic Search

After anterior cruciate ligament (ACL) reconstruction using a patellar-tendon autograft, 65 patients underwent second-look arthroscopy in conjunction with hardware removal. In 23 patients, hypertrophic tissue was found in the anterior part of the knee. This tissue presented different aspects, from a well-synovialized nodule to a more disorganized fibrous tissue according to patients' complaints. Endoscopic resection of this offending tissue was

P Delince

1998-01-01

247

An unusual epidemic of Staphylococcus-negative infections involving anterior cruciate ligament reconstruction with salvage of the graft and function.  

PubMed

We performed a retrospective study of 13 patients who had postoperative clinical and laboratory signs of infection after autogenous bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstructions. From January 1991 to November 1996 we experienced only 2 infected knees in 1,300 reconstructions, but between December 1996 and February 1997 10 patients in 70 ACL reconstructions developed a postoperative suspected infection. We found the origin of contamination (coagulase-negative Staphylococcus) in the supposedly sterile inflow cannula. When we changed this device, we had only 1 infection in the next 400 reconstructions. The diagnosis in these cases was derived from clinical signs and laboratory results, but only 2 of 11 samples of aspirated synovial fluid tested positive for Staphylococcus. The mean interval between the surgery and the onset of signs of infection and the start of antibiotic therapy was 7.7 days. All the patients had antibiotic association at the highest level. Six knees underwent arthroscopic debridement when the clinical signs indicated resistence to antibiotics. The normal postoperative rehabilitation program was modified but was not discontinued. Although recovery time was longer, overall results were similar to uncomplicated reconstructions. On the basis of our experience, we believe that when there is a notable increase in infection rates, a thorough search for contamination is indicated. Our source of infection was material that was thought to be sterile. Ultimately, early diagnosis and treatment is of critical importance to obtain good results. Even suspicion of infective postoperative complication should be sufficient cause to search for responsible microorganisms and begin antibiotic therapy. Arthroscopic debridement should be proposed to patients with resistence to antibiotics. PMID:10705329

Viola, R; Marzano, N; Vianello, R

2000-03-01

248

Anterior cruciate ligament reconstruction using a composite collagenous prosthesisA biomechanical and histologic study in rabbits  

Microsoft Academic Search

We evaluated a prototype composite collagenous an terior cruciate ligament replacement device designed to possess the advantages of biological grafts and syn thetic materials. Collagenous anterior cruciate ligament prostheses were made by embedding 225 reconsti tuted type I collagen fibers in a type I collagen matrix, and placing polymethylmethacrylate bone fixation plugs on the ends. The collagenous prosthesis was used

Michael G. Dunn; Alfred J. Tria; Y. Pedro Kato; Jeffrey R. Bechler; Robert S. Ochner; Joseph P. Zawadsky; Frederick H. Silver

1992-01-01

249

Femoral tunnel defect filled with a synthetic dowel graft for a single-staged revision anterior cruciate ligament reconstruction.  

PubMed

Bone defects are a common obstacle to successful revision anterior cruciate ligament (ACL) reconstruction. We describe the use of a synthetic bone graft plug to fill a cylindric defect after femoral interference screw removal. During revision ACL reconstruction performed through a 2-incision technique, we placed an outside-in guidewire for a new femoral tunnel that converged with the femoral screw from the primary ACL reconstruction. The screw was removed, and the resultant defect appeared very similar to the cylindric bone defect left after an osteochondral graft harvest. The confluence of the defect and the planned femoral tunnel would have allowed a "windshield wiper" effect of the graft at the lateral wall of the notch. We filled the screw defect with a synthetic bone graft plug to limit the aperture size of the femoral tunnel and to buttress the tendinous portion of the revision ACL graft, while maintaining proper anatomic graft position. In this article, we present a readily available all-arthroscopic option for repairing cylindric bone defects without the risk of an allograft or the morbidity of an autograft for a single-stage revision ACL reconstruction. PMID:17637422

Barrett, Gene R; Brown, Taylor D

2007-02-14

250

Isokinetic strength of the quadriceps and hamstrings and functional ability of anterior cruciate deficient knees in recreational athletes.  

PubMed Central

OBJECTIVE: To test the hypothesis that increasing the hamstrings and quadriceps (H:Q) isokinetic strength ratio will, in the short term, improve the functional ability of an anterior cruciate ligament (ACL) deficient knee. METHODS: The isokinetic muscular characteristics at a speed of 60 degrees s-1 and 180 degrees s-1 of 46 recreational athletes with an arthroscopically confirmed ACL tear were determined using the Cybex II+ isokinetic dynamometer. The variables tested included peak torque, endurance ratio, total work output, and explosive power. Functional ability was scored with the Cincinnati rating system, measuring the severity of pain and swelling, the degree of giving way, and the overall ability to walk, run, ascent and descent stairs, jump and twist. RESULTS: Among all muscular characteristics, the H:Q ratio at 180 degrees s-1 at 30 degrees of knee flexion was shown to have the highest correlation to the functional score (r = 0.6249, P < 0.001). All variables involving hamstring strength were shown to be significantly correlated to the functional ability score (P < 0.01), while none of the variables involving quadriceps strength showed significant correlation with the functional ability of the injured knee. CONCLUSIONS: The H:Q ratio is strongly correlated to the functional ability of ACL deficient knees in Chinese recreational athletes. It could be used as an additional measure to guide in the decision making process in the management of ACL deficient knees.

Li, R C; Maffulli, N; Hsu, Y C; Chan, K M

1996-01-01

251

Measurement of knee stiffness and laxity in patients with documented absence of the anterior cruciate ligament.  

PubMed

Thirty-five patients with documented absence of the anterior cruciate ligament were tested on the University of California, Los Angeles, instrumented clinical knee-testing apparatus and we measured the response curves for the following testing modes: anterior-posterior force versus displacement at full extension and at 20 and 90 degrees of flexion; varus-valgus moment versus angulation at full extension and 20 degrees of flexion; and tibial torque versus rotation at 20 degrees of flexion. Absolute values of stiffness and laxity and right-left differences for these injured knees were compared with identical quantities measured previously for a control population of forty-nine normal subjects with no history of treatment for injury to the knee. For both the uninjured knees and the knees without an anterior cruciate ligament, at 20 and 90 degrees of flexion the anterior-posterior laxity was greatest at approximately 15 degrees of external rotation of the foot. The injured knees demonstrated significantly increased total anterior-posterior laxity and decreased anterior stiffness when compared with the uninjured knees in all tested positions of the foot and knee. The mean increase in paired anterior-posterior laxity for the injured knees in this group of patients at +/- 200 newtons of applied anterior-posterior force was 3.1 millimeters (+39 per cent) at full extension, 5.5 millimeters (+57 per cent) at 20 degrees of flexion, and 2.5 millimeters (+34 per cent) at 90 degrees of flexion. The mean reduction in anterior stiffness for injured knees was also greatest (-54 per cent) at 20 degrees of knee flexion. Only slight reduction in posterior stiffness (-16 per cent) was measured at 20 degrees of flexion, and this probably reflected the presence of associated capsular and meniscal injuries. In the group of anterior cruciate-deficient knees, the patients with an absent medial meniscus showed greater total anterior-posterior laxity in all three positions of knee flexion than did the patients with an intact or torn meniscus. Varus-valgus laxity at full extension increased an average of 1.7 degrees (+36 per cent) for the injured knees, while varus and valgus stiffness decreased 21 per cent and 24 per cent. Absence of the medial meniscus (in a knee with absence of the anterior cruciate ligament) increased varus-valgus laxity at zero and 20 degrees of flexion.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:6693451

Markolf, K L; Kochan, A; Amstutz, H C

1984-02-01

252

The Effect of Functional Knee Bracing on the Anterior Cruciate Ligament in the Weightbearing and Nonweightbearing Knee  

Microsoft Academic Search

We investigated the effect of functional bracing on anterior cruciate ligament strain in humans by arthro scopic implantation of a differential variable reluctance transducer on the ligament and measurement of its strain behavior. Strains were measured while \\

Bruce D. Beynnon; Robert J. Johnson; Braden C. Fleming; Glenn D. Peura; Per A. Renstrom; Claude E. Nichols; Malcolm H. Pope

1997-01-01

253

Correlation between dynamic postural stability and muscle strength, anterior instability, and knee scale in anterior cruciate ligament deficient knees  

Microsoft Academic Search

Aim  The purpose of this study was to assess the correlations between dynamic postural stability and muscle strength, anterior\\u000a instability, and knee scores in anterior cruciate ligament (ACL) deficient knees.\\u000a \\u000a \\u000a \\u000a \\u000a Method  We examined 40 male patients with ACL injury prior to surgery. Maximal torques of flexors and extensors of the injured knee\\u000a at 60 and 180°\\/s were evaluated using an isokinetic testing

Won-Hah Park; Do-Kyung Kim; Jae Chul Yoo; Yong Seuk Lee; Ji-Hye Hwang; Moon Jong Chang; Yong Serk Park

2010-01-01

254

Arthroscopically assisted anterior decompression for femoroacetabular impingement: technique and early clinical results  

Microsoft Academic Search

Introduction  In patients with symptomatic femoroacetabular impingement resection osteochondroplasty of the femoral head–neck junction may\\u000a improve hip pain and range of motion. We evaluated the short-term treatment results of an arthroscopically assisted mini-open\\u000a anterior approach to compare it with the results after surgical dislocation for FAI.\\u000a \\u000a \\u000a \\u000a Methods  The clinical and radiographic results of 33 patients were reviewed retrospectively 15 months after the surgery.

Albrecht Hartmann; Klaus-Peter Günther

2009-01-01

255

Does wearing a functional knee brace affect hamstring reflex time in subjects with anterior cruciate ligament deficiency during muscle fatigue?  

Microsoft Academic Search

Lam RY, Ng GY, Chien EP. Does wearing a functional knee brace affect hamstring reflex time in subjects with anterior cruciate ligament deficiency during muscle fatigue? Arch Phys Med Rehabil 2002;83:1009-12. Objective: To evaluate the effects of wearing a functional knee brace and muscle fatigue on hamstring reflex time in subjects with anterior cruciate ligament (ACL) deficiency. Design: Repeated-measures clinical

Rita Y. Lam; Gabriel Y. Ng; Eric P. Chien

2002-01-01

256

Ultrasound evaluation of gravity induced anterior drawer following anterior cruciate ligament lesion.  

PubMed

Ultrasound is not so far a standard procedure to visualize the anterior drawer following anterior cruciate ligament (ACL) lesions. This is because the described techniques are either technically difficult or depend on the experience of the performer and are not standardized. The purpose of this prospective analysis on ACL intact, ACL deficient and ACL reconstructed knees was to compare the diagnostic accuracy of prone ultrasonographic Lachman testing with KT-1000 measurements in the same study population. Our technique is based on a prone position of the patient. The thigh lies on the table surface such that the patella has no contact. The lower leg is placed on a roll in the ankle area and flexed to 30 degrees . The transducer (5 MHz) is positioned over the medial aspect of the popliteal fossa to visualize the femoral condyle as well as the tibial head. Under ultrasound control the lower leg is manually lifted as far the thigh stays in contact with the surface defining the start position. The lower leg is then released and drawn by gravity into the anterior drawer position, the final position. The distance between the posterior tangent from the medial femoral condyle to the medial tibial plateau was registered by three independent ultrasound measurements of the injured knee. The uninvolved opposite knee served as an internal control. The same procedure was done using a KT-1000 device (89 and 133 Newton and manual maximum force). The patients were split into two groups: acute injury (A), and (B) 6 months following ACL repair with a patellar tendon graft. All patients then underwent arthroscopy. In group A with acute ACL lesions the anterior drawer resulted in 14.1 mm (+/- 3.5) and was significantly (P < 0.001) different from the contralateral knee (7.7 mm +/- 2.9). The KT 1000 showed a comparable difference with 14.4 mm (+/- 3.9) for the injured knee and 8.3 mm (+/- 3.4) for the uninjured (P < 0.001). Sonometrically, group B patients showed no clear difference between the repaired (9.9 mm +/- 2.7) knee and its control (8.1 mm +/- 2.5). This was found for the KT-1000 results as well. The results derived from the ultrasound evaluation of the anterior drawer correlated well with those from the KT-1000 (r = 0.46). Based on a minimum intra-individual difference of 5 mm in the ultrasound measured anterior drawer, the sensitivity of the test in group A resulted in 0.96, and the specificity in 0.98. The described technique is reproducible, painless and easy to perform in order to evaluate acute ACL tears using any commercially available ultrasound device. The reproducibility is similar to the KT-1000 device. We recommend this technique for use in cases of acute ACL tears as well as in the follow-up of ACL repair. PMID:10401653

Gebhard, F; Authenrieth, M; Strecker, W; Kinzl, L; Hehl, G

1999-01-01

257

Anatomic All-Inside Anterior Cruciate Ligament Reconstruction Using the Translateral Technique  

PubMed Central

There is growing evidence that anatomic placement of the femoral tunnel in anterior cruciate ligament reconstruction confers biomechanical advantages over the traditional tunnel position. The anteromedial portal technique for anatomic anterior cruciate ligament reconstruction has many well-described technical challenges. This article describes the translateral all-inside technique, which produces anatomic femoral tunnel placement using direct measurement of the medial wall of the lateral femoral condyle and outside-in drilling. All work is carried out through the lateral portal with all viewing through the medial portal. Thus there is no need for an accessory medial portal or hyperflexion of the knee during femoral socket preparation. A single quadrupled hamstring graft is used with cortical fixation at both the femoral and tibial tunnels.

Wilson, Adrian J.; Yasen, Sam K.; Nancoo, Tamara; Stannard, Roger; Smith, James O.; Logan, James S.

2013-01-01

258

Anterior cruciate ligament reconstruction creating the femoral tunnel through the anteromedial portal. Surgical technique.  

PubMed

The anterior cruciate ligament reconstruction is a common procedure that improves stability and function of the knee. The surgical technique continues to evolve and many issues are still under debate. These mainly include: (1) graft selection (patellar tendon, hamstring, quadriceps tendon, or allografts), (2) surgical technique (double versus single bundle), and (3) femoral tunnel drilling. Currently, the most controversial one is the femoral tunnel drilling (transtibial vs. anteromedial portal drilling). Common opinion is that drilling the femoral tunnel through the anteromedial (AM) allows a more anatomic placement of the graft and a better rotational stability; therefore, this technique is gaining in popularity compared with the transtibial drilling despite a greater difficulty and the risk of medial condyle damage, tunnel back wall blowout, and inadequate socket length. The aim of this article is to describe the surgical technique of the anterior cruciate ligament reconstruction (single and double bundle), drilling the femoral tunnel through the AM portal. PMID:21541700

Pastrone, Antonio; Ferro, Andrea; Bruzzone, Matteo; Bonasia, Davide E; Pellegrino, Pietro; D'Elicio, Davide; Cottino, Umberto; Rossi, Roberto

2011-06-01

259

The torn meniscus, the torn anterior cruciate ligament, and their relationship to degenerative joint disease.  

PubMed

A retrospective review of 350 knees was carried out to determine the effect, if any, of a torn meniscus and a torn anterior cruciate ligament on the articular surfaces of the knee. There were no professional or college athletes in this group, although a few were enthusiastic sandlot-type players. The time interval between injury and surgery was known, as was the state of the articular surfaces, which were graded from 1 to 4. As the time interval between injury and surgery increased, so did the incidence of lesions of the articular surfaces, although in most cases these lesions were quite minor. On the basis of this and other studies, it was concluded that the torn meniscus does not pose a significant threat to the integrity of the articular cartilage; this was also true in those patients in whom the anterior cruciate ligament was torn. PMID:4091906

Casscells, S W

1985-01-01

260

Postoperative analgesic effects of intra-articular bupivacaine and morphine after arthroscopic cruciate ligament surgery  

Microsoft Academic Search

Intra-articular administration of local anaesthetics such as bupivacaine can produce short-term postoperative analgesia in patients undergoing diagnostic arthroscopy or arthroscopic meniscectomy. A peripheral anti-nociceptive effect may also be induced by the administration of intra-articular opiates interacting with local opioid receptors in inflamed peripheral tissue. In the present study we aimed to study the analgesic effects of intraarticularly given bupivacaine and

J. Karlsson; B. Rydgren; B. Eriksson; U. Järvholm; O. Lundin; L. Swärd; T. Hedner

1995-01-01

261

Long term results of arthroscopic bankart repair for traumatic anterior shoulder instability  

PubMed Central

Background The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. We would like to report the 2 year clinical outcomes of bio-absorbable suture anchors used in traumatic anterior dislocations of the shoulder. Methods Data from 79 shoulders in 74 patients were collected over 4 years (2004 - 2008). Each patient was followed-up over a period of 2 years. The patients underwent arthroscopic Bankart repair using bio-absorbable suture anchors for their shoulder instability. These surgeries were performed at a single institution by a single surgeon over the time period. The patients were assessed with two different outcome measurement tools. The University of California at Los Angeles (UCLA) shoulder rating scale and the Simple Shoulder Test (SST) score. The scores were calculated before surgery and at the 2-year follow-up. The recurrence rates, range of motion as well post-operative function and return to sporting activities were evaluated. Results SST results from the 12 domains showed a significant improvement from a mean of 6.1 ± 3.1 to 11.1 ± 1.8 taken at the 2-year follow-up (p < 0.0001). Data from the UCLA scale showed a Pre and Post Operative Mean of 20.2 ± 5.0 and 32.4 ± 4.6 respectively (p < 0.0001). 34 had excellent post-operative scores, 35 had good scores, 1 had fair score and 3 had poor scores. 75% of the patients returned to sports while 7.6% developed a recurrence of shoulder dislocation or subluxation. Conclusion Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent post-operative shoulder motion and low recurrence rates.

2011-01-01

262

Telemetry system for monitoring anterior cruciate ligament graft forces in vivo  

Microsoft Academic Search

Quantifying changes in the tension of an anterior cruciate ligament (ACL) graft in vivo during rehabilitative exercises is\\u000a useful for developing the optimum rehabilitation for patients who have had reconstructive surgery. The purpose of the work\\u000a reported is to design, build and test a telemetry system that can measure the in vivo ACL graft tension post-operatively.\\u000a A commercially available fixation

E. L. McKee; D. P. Lindsey; M. L. Hull; S. M. Howell

1998-01-01

263

Neuromuscular and biomechanical landing performance subsequent to ipsilateral semitendinosus and gracilis autograft anterior cruciate ligament reconstruction  

Microsoft Academic Search

The hamstrings musculature is a vital component of an intricate dynamic knee joint restraint mechanism. However, there is\\u000a evidence based on research studies suggesting potential deficits to this complex mechanism due to donor site morbidity resulting\\u000a from harvest of the ipsilateral semitendinosus and gracilis autograft (ISGA) for anterior cruciate ligament reconstruction\\u000a (ACLR). The purpose of this retrospective research study was

Giampietro L. Vairo; Joseph B. Myers; Timothy C. Sell; Freddie H. Fu; Christopher D. Harner; Scott M. Lephart

2008-01-01

264

Early versus delayed surgery for anterior cruciate ligament reconstruction: a systematic review and meta-analysis  

Microsoft Academic Search

There is no consensus in the literature regarding the optimal timing of surgical reconstruction of the ruptured anterior cruciate\\u000a ligament (ACL). Previous authors have suggested that early reconstruction may facilitate an early return to work or sport\\u000a but may increase the incidence of post-operative complications such as arthrofibrosis. This study systematically reviewed\\u000a the literature to determine whether ACL reconstruction should

Toby O. Smith; Leigh Davies; Caroline B. Hing

2010-01-01

265

Reconstruction of the anterior cruciate ligament: dynamic strain evaluation of the graft  

Microsoft Academic Search

The study is focused on the biomechanical aspects of the anterior cruciate ligament (ACL) reconstruction procedures with an\\u000a emphasis on evaluating the dynamic strain of materials commonly used for this purpose. Separate and multiple, equally tensioned\\u000a strands of hamstring grafts used for the reconstruction of the ACL were biomechanically tested and compared to original ACL\\u000a and bone-patellar tendon-bone (BPTB) grafts,

Milan Handl; Milan Držík; Giuliano Cerulli; Ctibor Povýšil; Juraj Chlpík; Ferdinand Varga; Evžen Amler; Tomáš Tr?

2007-01-01

266

Open- or closed-kinetic chain exercises after anterior cruciate ligament reconstruction?  

PubMed

Open-kinetic chain (OKC) and closed-kinetic chain (CKC) exercises may not differ in their effects on the healing response of the anterior cruciate ligament (ACL)-reconstructed knee. Recent biomechanical studies have shown that the peak strains produced on a graft are similar. Clinical studies suggest that both play a beneficial role in the early rehabilitation of the reconstructed knee. PMID:16006821

Fleming, Braden C; Oksendahl, Heidi; Beynnon, Bruce D

2005-07-01

267

Postoperative Analgesia with Controlled-Release Oxycodone for Outpatient Anterior Cruciate Ligament Surgery  

Microsoft Academic Search

Reconstruction of the anterior cruciate ligament (ACL) of the knee is associated with a considerable degree of post- operative pain. Although immediate-release oral opioids are usually effective in relieving moderate to severe pain, they must be given every 4-6 h. A controlled-release (CR) formulation of oxycodone maintains therapeutic opioid concentrations for a more prolonged period, thus provid- ing sustained pain

Scott S. Reuben; Neil Roy Connelly; Holly Maciolek

1999-01-01

268

Collagen-Platelet Composite Enhances Biomechanical and Histologic Healing of the Porcine Anterior Cruciate Ligament  

Microsoft Academic Search

Background: The anterior cruciate ligament (ACL) fails to heal after traumatic rupture. Furthermore, large-animal models have recently shown that 1-month functional ACL healing is augmented after suture repair when a bioactive scaffold is placed in the tear site.Hypothesis: At the time of suture repair, placement of a bioactive scaffold in the ACL wound site would improve the structural properties of

Shilpa M. Joshi; Ashley N. Mastrangelo; Elise M. Magarian; Braden C. Fleming; Martha M. Murray

2009-01-01

269

Double-Bundle Anterior Cruciate Ligament Reconstruction in a Skeletally Immature Adolescent Athlete  

Microsoft Academic Search

We present a technique for double-bundle anterior cruciate ligament (ACL) reconstruction in a 14-year-old female athlete. The patient presented with anterolateral knee rotatory instability following a traumatic injury suffered while practicing judo. The clinical examination revealed positive Lachman and pivot shift tests with no accompanying meniscal pathology. Roentgenograms revealed open physes, and magnetic resonance imaging scans confirmed an isolated midsubstance

Gian M. Salzmann; Jeffrey T. Spang; Andreas B. Imhoff

2009-01-01

270

Intraarticular stabilization after anterior cruciate ligament tear in children and adolescents: results 6 years after surgery  

Microsoft Academic Search

Tear of the anterior cruciate ligament (ACL) secondary to knee sprain injury is also quite common among children and adolescents.\\u000a Whether reconstruction is indicated and which technique should be employed is still controversial. The debate focuses on the\\u000a possible risk of growth plate damages due to intraarticular operative reconstruction techniques. For more details on benefit\\u000a and risks of operative stabilization,

H. M. Gaulrapp; J. Haus

2006-01-01

271

Stump entrapment of the anterior cruciate ligament in late childhood and adolescence  

Microsoft Academic Search

Displacement of a portion of the torn anterior cruciate ligament (ACL) into the intercondylar notch can cause a focal fibrotic\\u000a reaction similar to that seen following ACL reconstruction. This displacement, which can result in locking or limitation of\\u000a knee extension, is termed stump entrapment and is described in adult MR imaging literature. We present a pictorial essay of the etiology

Arthur B. Meyers; Tal Laor; Andrew M. Zbojniewicz

272

Deep lateral femoral sulcus: study of 124 patients with anterior cruciate ligament tear  

Microsoft Academic Search

Abnormal deepening of the lateral femoral sulcus has been proposed as a potential indirect sign allowing the diagnosis of\\u000a an anterior cruciate ligament (ACL) tear on conventional lateral knee radiographs. We studied a large group of patients with\\u000a proven ACL tears during the acute injury and at 5-year follow-up to determine (a) the normal range of the depth of this

Joseph S. Yu; Enrique Bosch; Mini N. Pathria; Megan McAndless; Dave Mishra; Dale Daniel; Paul Clopton; Donald Resnick

1995-01-01

273

Increased medial tibial slope in teenage pediatric population with open physes and anterior cruciate ligament injuries  

Microsoft Academic Search

Purpose  Variations in bony morphology have been associated with anterior cruciate ligament (ACL) injury risk. The primary aim of this\\u000a study was to compare the tibial slope in the teenage pediatric population with open physes, with and without ACL injury. The\\u000a secondary aims were to compare the notch width index (NWI) and determine the influence of gender and age on tibial

Shail Vyas; Carola F. van Eck; Nina Vyas; Freddie H. Fu; Norman Y. Otsuka

2011-01-01

274

The association between the COL12A1 gene and anterior cruciate ligament ruptures  

Microsoft Academic Search

BackgroundAnterior cruciate ligament (ACL) ruptures are among the most severe musculoskeletal soft tissue injuries. However, the exact mechanisms which cause these acute injuries are unknown. Recently, sequence variants within two genes, namely COL1A1 and COL5A1, which code for the ?1 chains of types I and V collagen respectively, were shown to be associated with ACL ruptures. Type XII collagen, similarly

Michael Posthumus; Alison V September; Dion OCuinneagain; Willem van der Merwe; Martin P Schwellnus; Malcolm Collins

2010-01-01

275

Quantitation of estrogen receptors and relaxin binding in human anterior cruciate ligament fibroblasts  

Microsoft Academic Search

Summary  The significantly higher incidence of anterior cruciate ligament (ACL) injuries in collegiate women compared with men may\\u000a result from relative ligament laxity. Differences in estrogen and relaxin activity, similar to that seen in pregnancy, may\\u000a account for this. We quantified estrogen receptors by flow cytometry and relaxin receptors by radioligand binding assay in\\u000a human ACL cells and compared the presence

Deborah A. Faryniarz; Madhu Bhargava; Claudette Lajam; Erik T. Attia; Jo A. Hannafin

2006-01-01

276

Adaptations in single-leg hop biomechanics following anterior cruciate ligament reconstruction  

Microsoft Academic Search

When a patient performs a clinically normal hop test based on distance, it cannot be assumed that the biomechanics are similar\\u000a between limbs. The objective was to compare takeoff and landing biomechanics between legs in patients who have undergone anterior\\u000a cruciate ligament reconstruction. Kinematics and ground reaction forces were recorded as 13 patients performed the single-leg\\u000a hop on each leg.

Karl F. OrishimoIan; Ian J. Kremenic; Michael J. Mullaney; Malachy P. McHugh; Stephen J. Nicholas

2010-01-01

277

Magnetic resonance imagination of the peroneus longus tendon after anterior cruciate ligament reconstruction  

Microsoft Academic Search

Several studies report that tendons can regenerate after harvesting. These studies have been performed especially in patellar\\u000a and hamstring tendons. At our institution, 10 cm length of full thickness peroneus longus tendon has been harvested to reconstruct\\u000a torn anterior cruciate ligament since 1997 as a different graft source. The aim of this study was to investigate whether the\\u000a peroneus longus tendon

Servet Kerimo?lu; Polat Ko?ucu; Murat Livao?lu; Ismail Yükünç; Ahmet U?ur Turhan

2009-01-01

278

Four-strand hamstring tendon autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction  

Microsoft Academic Search

This retrospective study compared the results after anterior cruciate ligament (ACL) reconstruction using a four-strand hamstring\\u000a tendon graft (4SHG) versus Ligament Advanced Reinforcement System (LARS) artificial ligament in 60 patients between January\\u000a 2003 and July 2004 with a minimum four-year follow-up. The KT-1000 examination, the International Knee Documentation Committee\\u000a (IKDC) scoring systems and Lysholm knee scoring scale were used to

Zhong-tang Liu; Xian-long Zhang; Yao Jiang; Bing-Fang Zeng

2010-01-01

279

Comparative Study on Anterior Cruciate Ligament Reconstruction: Determination of Isometric Points with and Without Navigation  

PubMed Central

OBJECTIVES: To compare the accuracy of tunnel placement and graft isometry for anterior cruciate ligament reconstruction performed using a computer-assisted navigation system (Orthopilot) and using traditional instruments. METHODS: The anterior cruciate ligament was removed intact from 36 pairs of human cadaver knees. From each pair, one knee was randomized to Group 1 (conventional) and the other to Group 2 (Orthopilot). An inelastic suture was then passed through the central points of the tibial and femoral tunnels. Neither of the tunnels was drilled. All knees were then dissected, and six parameters were obtained: distances from the tibial tunnel center to the 1) posterior cruciate ligament, 2) anterior horn of the lateral meniscus and 3) medial tibial spine; 4) distance from the femoral tunnel center to the posterior femoral cortex; 5) femoral tunnel coronal angle; and 6) variation of the distance from the femoral to the tibial tunnel with the knee extended and at 90 degrees of flexion. RESULTS: The variation of the distance from the femoral to the tibial tunnel during flexion and extension was smaller in the Orthopilot group (better isometry) compared to the conventional group. There were no statistical differences in any other parameters between the groups, and all tunnels were considered to be in satisfactory positions. DISCUSSION: The results obtained for anterior cruciate ligament reconstruction depend on precise isometric point positioning, and a navigation system is a precision tool that can assist surgeons in tunnel positioning. CONCLUSION: No differences in tunnel position were observed between the groups. Nonetheless, better isometry was achieved in the Orthopilot group than with conventional instruments.

Angelini, Fabio J.; Albuquerque, Roberto F. M.; Sasaki, Sandra U.; Camanho, Gilberto L.; Hernandez, Arnaldo J.

2010-01-01

280

Measurement of brake response time after right anterior cruciate ligament reconstruction  

Microsoft Academic Search

Objective: Recommendations on safe driving after anterior cruciate ligament (ACL) reconstruction have been largely intuitive. We studied brake response time in patients who participated in outpatient rehabilitation after right ACL reconstruction.Design: Prospective, repeated measures design comparing 14 patients post-ACL reconstruction with 21 subjects with normal knees.Interventions and Main Outcome Measures: The following measures were assessed every 2 weeks for 10

Robert S. Gotlin; Andrew L. Sherman; Nelson Sierra; Michael A. Kelly; Zinon Pappas; W. Norman Scott

2000-01-01

281

The diagnostic accuracy of anterior cruciate ligament rupture using magnetic resonance imaging: a meta-analysis  

Microsoft Academic Search

This study evaluates the diagnostic accuracy of anterior cruciate ligament (ACL) rupture using magnetic resonance imaging\\u000a in the management of patients with symptomatic tibiofemoral instability. Published and unpublished databases including the\\u000a Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED and CINAHL, as well as unpublished studies registers were searched for studies that compared the diagnostic findings\\u000a of MRI to

T. O. Smith; M. Lewis; F. Song; A. P. Toms; S. T. Donell; C. B. Hing

282

Anterior cruciate ligament reconstruction using cryopreserved irradiated bone-ACL-bone-allograft transplants  

Microsoft Academic Search

Bone-ACL-bone allograft transplantation has been investigated as a potential solution to reconstruction of the anterior cruciate ligament (ACL). To minimize disease transmission (e.g. the acquired immuno deficiency syndrome), bony and collagenous tissues should be sterilized. Recent animal studies indicate that gamma irradiation and ethylene oxide sterilization result in diminished histological and biomechanical properties. The purpose of the present study was

M. J. Goertzen; H. Clahsen; K. F. Biirrig; K.-P. Schulitz

1994-01-01

283

RETRACTED ARTICLE: The effect of graft choice on functional outcome in anterior cruciate ligament reconstruction  

Microsoft Academic Search

A prospective, randomised, 5-year follow-up study was designed to compare the functional results between patellar tendon and\\u000a hamstring tendon autografts after anterior cruciate ligament reconstruction. Primary reconstruction was performed in 32 patients\\u000a using the central third of the patellar ligament and in 32 patients using double-looped semitendinosus and gracilis tendons.\\u000a All reconstructions were performed by a single surgeon, with identical

Matjaž Sajovic; Andrej Strahovnik; Radko Komadina; Mojca Z. Dernovšek

2008-01-01

284

Serial dilation versus extraction drilling in anterior cruciate ligament reconstruction: a biomechanical study  

Microsoft Academic Search

The hamstring tendon graft has become increasingly popular in anterior cruciate ligament reconstruction because of low donor-site\\u000a morbidity. However, the tibial fixation is considered difficult, mainly because of low tibial mineral bone density. Therefore,\\u000a we tested whether preparation of the tibial tunnel with compaction by serial dilation provided a stronger anchorage of the\\u000a graft–fixation-device complex than does traditional extraction drilling

O. G. Sørensen; B. W. Jakobsen; S. Kold; T. B. Hansen; K. Søballe

2010-01-01

285

Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines  

Microsoft Academic Search

Purpose  Anterior cruciate ligament (ACL) mucoid degeneration is a rare encounter in clinical practice, different, but often confused\\u000a with ACL mucoid cysts. Its pathophysiology remains unclear. However, recent publications have suggested that it might be underdiagnosed\\u000a or misdiagnosed, and that the adverse effects of treatment by ACL resection might be underestimated. The object of this work\\u000a was to summarize this scattered

Francois Lintz; Nicolas Pujol; Philippe Boisrenoult; Kevin Bargoin; Philippe Beaufils; David Dejour

2011-01-01

286

Revision anterior cruciate ligament reconstruction using autografts with a polyester fixation device  

Microsoft Academic Search

Twenty-nine patients who had undergone anterior cruciate ligament (ACL) revision were evaluated retrospectively between 1992 and 2000. A similar surgical technique was used in all cases. Twenty-six patients underwent revision following failed primary and revision surgery with the ABC scaffold ligament. There were 2 failed primary semitendinosus\\/gracilis (STG) autografts and one failed bone patella tendon bone (BPTB) autograft. Autologous hamstring

Peter J. Fules; Rohit T. Madhav; Richard K. Goddard; Michael A. S. Mowbray

2003-01-01

287

Return-to-Sport Outcomes at 2 to 7 Years After Anterior Cruciate Ligament Reconstruction Surgery  

Microsoft Academic Search

Background: Most people have not returned to their preinjury level of sports participation at 12 months after anterior cruciate ligament (ACL) reconstruction surgery. Twelve months’ follow-up may be too early to assess return-to-sport outcomes accurately.Purpose: This study was undertaken to evaluate the medium-term return-to-sport outcomes after ACL reconstruction surgery.Study Design: Case series; Level of evidence, 3.Methods: A self-report questionnaire was

Clare L. Ardern; Nicholas F. Taylor; Julian A. Feller; Kate E. Webster

2012-01-01

288

Long-term results of the Leeds-Keio anterior cruciate ligament reconstruction  

Microsoft Academic Search

This paper discusses the long-term results of the anterior cruciate ligament (ACL) reconstruction with the Leeds-Keio (LK) prosthetic ligament. For this type of reconstruction we used arthrotomy and an arthroscopy-assisted technique. The fixation was obtained with two bone plugs, and the distal portion was also attached with a staple. A postoperative protocol was used with a progressive range of motion

M. Denti; M. Bigoni; G. Dodaro; M. Monteleone; A. Arosio

1995-01-01

289

Locked bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency.  

PubMed

Because we noticed patients had difficulty regaining full range of motion after surgery for a locked bucket-handle meniscal tear with simultaneous reconstruction for a chronic anterior cruciate ligament tear, we adopted a two-stage procedure for this group of patients. We evaluated the results of a two-stage procedure in the knees of 16 athletes (Group 1) and compared their outcome with the outcome of 16 matched athletes who had been treated with simultaneous repair or removal of the displaced bucket-handle meniscal tear and autogenous patellar tendon anterior cruciate ligament reconstruction (Group 2). Four patients in Group 2 required a second procedure or casting to regain full extension. No patient in Group 1 required a second procedure. One meniscal retear was detected in Group 1. The two-stage procedure also appears to have a number of theoretical advantages: 1) more aggressive use of repair rather than removal of a displaced torn meniscus, 2) prevention of problems in regaining range of motion, 3) allows a second look to judge the success of meniscal repair, and 4) allows time for the patient to prepare for anterior cruciate ligament reconstruction physically, mentally, academically, and socially. PMID:8291626

Shelbourne, K D; Johnson, G E

290

The Strain Behavior of the Anterior Cruciate Ligament During Squatting and Active Flexion-ExtensionA Comparison of an Open and a Closed Kinetic Chain Exercise  

Microsoft Academic Search

The effects of weightbearing (closed kinetic chain) and nonweightbearing (open kinetic chain) exercises on the biomechanical behavior of an injured anterior cru ciate ligament or a healing anterior cruciate ligament graft are unknown. To understand the effects of these exercises on the healing graft, we measured the strain behavior of the normal anterior cruciate ligament in human subjects while they

Bruce D. Beynnon; Robert J. Johnson; Braden C. Fleming; Charles J. Stankewich; Per A. Renström; Claude E. Nichols

1997-01-01

291

Intercondylar Notch Stenosis Is Not a Risk Factor for Anterior Cruciate Ligament Tears in Professional Male Basketball PlayersAn 11Year Prospective Study  

Microsoft Academic Search

Background:The value of femoral notch size and the notch width index in predicting anterior cruciate ligament injury has been debated. This study examined the relationship between the notch width index and anterior cruciate ligament injury in professional basketball players.Hypothesis:No significant difference exists between the notch width index of anterior cruciate ligament–injured and noninjured professional basketball players.Study Design:Case-control study; Level of

Stephen Lombardo; Paul M. Sethi; Chad Starkey

2005-01-01

292

Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female AthletesA Prospective Study  

Microsoft Academic Search

Background: Female athletes participating in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than do male athletes.Hypothesis: Prescreened female athletes with subsequent anterior cruciate ligament injury will demonstrate decreased neuromuscular control and increased valgus joint loading, predicting anterior cruciate ligament injury risk.Study Design: Cohort study; Level of evidence, 2.Methods: There were 205 female athletes

Timothy E. Hewett; Gregory D. Myer; Kevin R. Ford; Robert S. Heidt; Angelo J. Colosimo; Scott G. McLean; Antonie J. van den Bogert; Mark V. Paterno; Paul Succop

2005-01-01

293

Effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability.  

PubMed

Background? Anterior instability is a frequent complication following a traumatic glenohumeral dislocation. Frequently the underlying pathology associated with recurrent instability is a Bankart lesion. Surgical correction of Bankart lesions and other associated pathology is the key to successful treatment. Open surgical glenohumeral stabilisation has been advocated as the gold standard because of consistently low postoperative recurrent instability rates. However, arthroscopic glenohumeral stabilisation could challenge open surgical repair as the gold standard treatment for traumatic anterior glenohumeral instability. Objectives? Primary evidence that compared the effectiveness of arthroscopic versus open surgical glenohumeral stabilisation was systematically collated regarding best-practice management for adults with traumatic anterior glenohumeral instability. Search strategy? A systematic search was performed using 14 databases: MEDLINE, Cumulative Index of Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), ISI Web of Science, Expanded Academic ASAP, Proquest Medical Library, Evidence Based Medicine Reviews, Physiotherapy Evidence Database, TRIP Database, PubMed, ISI Current Contents Connect, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Studies published between January 1984 and December 2004 were included in this review. No language restrictions were applied. Selection criteria? Eligible studies were those that compared the effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability, which had more than 2?years of follow up and used recurrent instability and a functional shoulder questionnaire as primary outcomes. Studies that used non-anatomical open repair techniques, patient groups that were specifically 40?years or older, or had multidirectional instability or other concomitant shoulder pathology were excluded. Data collection and analysis? Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion with an independent researcher. Studies were assessed for homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format; otherwise a meta-analysis was conducted. Results? Eleven studies were included in the review. Two were randomised controlled trials. Evidence comparing arthroscopic and open surgical glenohumeral stabilisation was of poor to fair methodological quality. Hence, the results of primary studies should be interpreted with caution. Observed clinical heterogeneity in populations and outcomes was highlighted and should be considered when interpreting the meta-analysis. Authors also used variable definitions of recurrent instability and a variety of outcome measures, which made it difficult to synthesise results. When comparable data were pooled, there were no significant differences (P?>?0.05) between the arthroscopic and open groups with respect to recurrent instability rates, Rowe score, glenohumeral external rotation range and complication rates. Conclusions? Statistically, it appears that both surgical techniques are equally effective in managing traumatic anterior glenohumeral instability. In light of the methodological quality of the included studies, it is not possible to validate arthoscopic stabilisation to match open surgical stabilisation as the gold standard treatment. Further research using multicentred randomised controlled trials with sufficient power and instability-specific questionnaires with sound psychometric properties is recommended to build on current evidence. The choice of treatment should be based on multiple factors between the clinician and the patient. PMID:21631787

Ng, Choong; Bialocerkowski, Andrea; Hinman, Rana

2007-06-01

294

An In Vitro Biomechanical Comparison of Anterior Cruciate Ligament Reconstruction: Single Bundle Versus Anatomical Double Bundle Techniques  

PubMed Central

INTRODUCTION Anterior cruciate ligament ruptures are frequent, especially in sports. Surgical reconstruction with autologous grafts is widely employed in the international literature. Controversies remain with respect to technique variations as continuous research for improvement takes place. One of these variations is the anatomical double bundle technique, which is performed instead of the conventional single bundle technique. More recently, there has been a tendency towards positioning the two bundles through double bone tunnels in the femur and tibia (anatomical reconstruction). OBJECTIVES To compare, through biomechanical tests, the practice of anatomical double bundle anterior cruciate ligament reconstruction with a patellar graft to conventional single bundle reconstruction with the same amount of patellar graft in a paired experimental cadaver study. METHODS Nine pairs of male cadaver knees ranging in age from 44 to 63 years were randomized into two groups: group A (single bundle) and group B (anatomical reconstruction). Each knee was biomechanically tested under three conditions: intact anterior cruciate ligament, reconstructed anterior cruciate ligament, and injured anterior cruciate ligament. Maximum anterior dislocation, rigidity, and passive internal tibia rotation were recorded with knees submitted to a 100 N horizontal anterior dislocation force applied to the tibia with the knees at 30, 60 and 90 degrees of flexion. RESULTS There were no differences between the two techniques for any of the measurements by ANOVA tests. CONCLUSION The technique of anatomical double bundle reconstruction of the anterior cruciate ligament with bone-patellar tendon-bone graft has a similar biomechanical behavior with regard to anterior tibial dislocation, rigidity, and passive internal tibial rotation.

Sasaki, Sandra Umeda; Albuquerque, Roberto Freire da Mota e; Pereira, Cesar Augusto Martins; Gouveia, Guilherme Simoes; Vilela, Julio Cesar Rodrigues; de Lima Alcaras, Fabio

2008-01-01

295

Effect of Varying Hamstring Tension on Anterior Cruciate Ligament Strain During in Vitro Impulsive Knee Flexion and Compression Loading  

PubMed Central

Background: The hamstring muscles are well positioned to limit both anterior tibial translation and anterior cruciate ligament strain during the knee flexion phase of a jump landing. We hypothesized that systematically increasing or decreasing hamstring tension during the knee flexion phase of a simulated jump landing would significantly affect peak relative strain in the anterior cruciate ligament. Methods: Ten cadaveric knees from four male and six female donors (mean age [and standard deviation] at the time of death, 60.3 ± 23.6 years) were mounted in a custom fixture to initially position the specimen in 25° of knee flexion and simulate axial impulsive loading averaging 1700 N to cause an increase in knee flexion. Quadriceps, hamstring, and gastrocnemius muscle forces were simulated with use of pretensioned linear springs, with the tension in the hamstrings arranged to be increased, held constant, decreased, at “baseline,” or absent during knee flexion. Impulsive loading applied along the tibia and femur was monitored with use of triaxial load transducers, while uniaxial load cells monitored quadriceps and medial and lateral hamstring forces. Relative strain in the anterior cruciate ligament was measured with use of a differential variable reluctance transducer, and tibiofemoral kinematics were measured optoelectronically. For each specimen, anterior cruciate ligament strains were recorded over eighty impact trials: ten preconditioning trials, ten “baseline” trials involving decreasing hamstring tension performed before and after three sets of ten trials conducted with increasing hamstring tension, constant hamstring tension, or no hamstring tension. Peak relative strains in the anterior cruciate ligament were normalized for comparison across specimens. Results: Increasing hamstring force during the knee flexion landing phase decreased the peak relative strain in the anterior cruciate ligament by >70% compared with the baseline condition (p = 0.005). Neither a constant hamstring muscle force nor the absence of a hamstring force significantly changed the peak strain in the anterior cruciate ligament relative to the baseline condition. Conclusions: Increasing hamstring muscle force during the knee flexion phase of a simulated jump landing significantly reduces the peak relative strain in the anterior cruciate ligament in vitro. Clinical Relevance: It may be possible to proactively limit peak anterior cruciate ligament strain during the knee flexion phase of jump landings by accentuating hip flexion, thereby increasing the tension in active hamstring muscles by lengthening them.

Withrow, Thomas J.; Huston, Laura J.; Wojtys, Edward M.; Ashton-Miller, James A.

2008-01-01

296

Bone Tunnel Enlargement After Anterior Cruciate Ligament Replacement  

Microsoft Academic Search

Radiographic increase in the size of tibial and femoral tunnels has been observed. This retrospective study compared tibial tunnel diameter in 56 autograft and 87 allograft patellar tendon bone-tendon-bone anterior cru ciate ligament replacements whose observed tunnel changes were correlated with clinical results at 1 year postoperatively. Tibial tunnel sclerotic margins were measured approximately 1 cm below the joint line.

Mark Fahey; Peter A. Indelicato

1994-01-01

297

Magnetic resonance imaging of anterior cruciate ligament (ACL) tears: Diagnostic value of ACL-tibial plateau angle  

Microsoft Academic Search

Tears of the anterior cruciate ligament (ACL) are often difficult to diagnose on magnetic resonance imaging (MRI), as it is often difficult to interpret the images. We developed a quantitative method for diagnosing ACL tears on MRI; the method involves measuring the angle formed by the intersection between a straight line drawn along the anterior border of the ACL and

Hiroshi Murao; Shinobu Morishita; Mikio Nakajima; Muneaki Abe

1998-01-01

298

Estrogen Affects the Cellular Metabolism of the Anterior Cruciate LigamentA Potential Explanation for Female Athletic Injury  

Microsoft Academic Search

Investigations from this laboratory have established the presence of estrogen receptors in the human an terior cruciate ligament. This study further investigates the effects of 17?-estradiol on the cellular proliferation and collagen synthesis of fibroblasts derived from the rabbit anterior cruciate ligament. Fibroblast prolifera tion and collagen synthesis in response to near log concentrations of 17?-estradiol (at 0.0029, 0.025, 0.25,

Stephen H. Liu; Raad A. Al-Shaikh; Vahé Panossian; Gerald A. M. Finerman

1997-01-01

299

MRI evaluation of tibial tunnel wall cortical bone formation after platelet-rich plasma applied during anterior cruciate ligament reconstruction  

PubMed Central

Background After anterior cruciate ligament (ACL) reconstruction, formation of cortical sclerotic bone encircling the femoral and tibial tunnel is a part of intratunnel graft healing. During the physiological cascades of soft tissue healing and bone growth, cellular and hormonal factors play an important role. The purpose of this study was to non-invasively but quantitatively assess the effect of intraoperatively applied platelet-rich plasma (PRP) on the formation of cortical bone encircling the tibial tunnel. Patients and methods In fifty patients, standard arthroscopic ACL reconstructions were performed. The PRP group (n = 25) received a local application of PRP while the control group (n = 25) did not receive PRP. The proximal tibial tunnel was examined by MRI in the paraxial plane where the portion of the tibial tunnel wall circumference consisting of sclerotic cortical bone was assessed with testing occurring at one, two and a half and six months after surgery. Results At one month after surgery, differences between the groups in the amount of cortical sclerotic bone encircling the tunnel were not significant (p = 0.928). At two and a half months, the sclerotic portion of the tunnel wall in the PRP group (36.2%) was significantly larger than in the control (22.5%) group (p = 0.004). At six months, the portion of sclerotic bone in the PRP group (67.1%) was also significantly larger than in the control (53.5%) group (p = 0.003). Conclusions Enhanced cortical bone formation encircling the tibial tunnel at 2.5 and 6 months after ACL graft reconstruction results from locally applied platelet-rich plasma.

Rupreht, Mitja; Vogrin, Matjaz; Hussein, Mohsen

2013-01-01

300

The Relationship Between Intercondylar Notch Width of the Femur and the Incidence of Anterior Cruciate Ligament TearsA Prospective Study  

Microsoft Academic Search

For 714 consecutive patients who underwent autogenous patellar tendon graft anterior cruciate ligament reconstructions we intraoperatively measured intercondylar notch width. We prospectively recorded height, weight, sex, and which patients subsequently tore their contralateral anterior cruciate ligament or the 10-mm autograft. The patients were divided into two groups based on notch width (group 1, 15 mm; group 2, 16 mm). The

K. Donald Shelbourne; Thorp J. Davis; Thomas E. Klootwyk

1998-01-01

301

Effect of Muscle Loads and Torque Applied to the Tibia on the Strain Behavior of the Anterior Cruciate Ligament: An In Vitro Investigation  

PubMed Central

Background Very little is known about the effects of applied torque about the long axis of the tibia in combination with muscle loads on anterior cruciate ligament biomechanics. The purpose of this study was to determine the effect of muscle contraction and tibial torques applied about the long axis of the tibia on anterior cruciate ligament strain behavior. Methods Six cadaver knee specimens were used to measure the strain behaviour of the anterior cruciate ligament. Internal and external axial torques were applied to the tibia when the knee was between 30° and 120° of flexion in combination with the conditions of no muscle load, isolated quadriceps load, and simultaneous quadriceps and hamstring loading. Findings The highest anterior cruciate ligament strain values were measured when the muscles were not loaded, when the knee was at 120° of flexion, and when internal tibial torques were applied to the knee. During muscle loading the highest anterior cruciate ligament strain values were measured at 30° of flexion and then the strain values gradually decreased with increase in knee flexion. During co-contraction of the quadriceps and hamstring muscles the anterior cruciate ligament was unstrained or minimally strained at 60°, 90° and 120° of knee flexion. Intepretation This study suggests that quadriceps and hamstring muscle co-contraction has a potential role in reducing the anterior cruciate ligament strain values when the knee is in deep flexion. These results can be used to gain insight into anterior cruciate ligament injury mechanisms and to design rehabilitation regimens.

Fujiya, Hiroto; Kousa, Petteri; Fleming, Braden C; Churchill, David L; Beynnon, Bruce D

2011-01-01

302

Minimum 10Year Results After Anterior Cruciate Ligament ReconstructionHow the Loss of Normal Knee Motion Compounds Other Factors Related to the Development of Osteoarthritis After Surgery  

Microsoft Academic Search

Background: Few long-term studies exist that evaluate how the loss of normal knee range of motion affects results after anterior cruciate ligament reconstruction.Hypothesis: Patients with normal knee motion will have higher subjective scores than patients with less than normal motion. Study Design: Cohort study; Level of evidence, 2.Methods: Patients were prospectively evaluated at > 10 years after anterior cruciate ligament

K. Donald Shelbourne; Tinker Gray

2009-01-01

303

Characterization of anterior cruciate ligament cells and bone marrow stromal cells on various biodegradable polymeric films  

Microsoft Academic Search

In this study, the adhesion, proliferation and morphology of rabbit anterior cruciate ligament (ACL) cells and bone marrow stromal cells (bMSCs) on synthetic biodegradable polymeric films were investigated. Tissue culture polystyrene (TCP) was used as control. Seven biodegradable polymers were used; they are as follows: poly(?-caprolactone) (PCL), poly(dl-lactide) (d-PLA), poly(l-lactide) (l-PLA), PLA\\/PCL (50:50), PLA\\/PCL (75:25), high molecular weight (HMW) poly(dl-lactide–co-glycolide

H. W. Ouyang; J. C. H. Goh; X. M. Mo; S. H. Teoh; E. H. Lee

2002-01-01

304

Association between intercondylar notch narrowing and bilateral anterior cruciate ligament injuries in athletes  

Microsoft Academic Search

Background  Intercondylar notch narrowing is a risk factor for anterior cruciate ligament (ACL) injuries, but it is unclear whether a\\u000a narrow intercondylar notch correlates with bilateral ACL injuries.\\u000a \\u000a \\u000a \\u000a \\u000a Purpose  To determine whether a narrow intercondylar notch is associated with bilateral ACL knee injuries in athletes, using magnetic\\u000a resonance imaging (MRI) and radiography to investigate the notch size.\\u000a \\u000a \\u000a \\u000a \\u000a Study design  A retrospective case–control study.

Koh Hoteya; Yuki Kato; Sayaka Motojima; Sheila J. Ingham; Takashi Horaguchi; Akiyoshi Saito; Yasuaki Tokuhashi

2011-01-01

305

Cost Analysis of Outpatient Anterior Cruciate Ligament Reconstruction: Autograft versus Allograft  

Microsoft Academic Search

Background  Prior studies suggest the cost of allograft anterior cruciate ligament (ACL) reconstruction is less than that for autograft\\u000a reconstruction. Charges in these studies were influenced by patients requiring inpatient hospitalization.\\u000a \\u000a \\u000a \\u000a \\u000a Question\\/purpose  We therefore determined if allograft ACL reconstruction would still be less costly if all procedures were performed in a completely\\u000a outpatient setting.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We retrospectively reviewed 155 patients who underwent ACL

Sameer H. Nagda; Grant G. Altobelli; Kevin A. Bowdry; Clive E. Brewster; Stephen J. Lombardo

2010-01-01

306

Meniscal repair in anterior cruciate ligament reconstruction: a long-term outcome study  

Microsoft Academic Search

Purpose  To study the long-term outcome of patients who have undergone inside-out, vertical stacked mattress suture repair of meniscal\\u000a tears combined with anterior cruciate ligament (ACL) reconstruction.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  From a database of ACL reconstructed patients, consecutive patients undergoing concomitant meniscal repair and ACL reconstruction\\u000a between 1991 and 1999 were identified. Patients with previous ACL or meniscal pathology were excluded. Two age- and

J. T. K. Melton; J. R. Murray; A. Karim; H. Pandit; F. Wandless; N. P. Thomas

307

Embolism of the popliteal artery after anterior cruciate ligament reconstruction: a case report and literature review  

PubMed Central

Arterial complications after anterior cruciate ligament reconstruction (ACLR) are rare. We present a case report of a 44-year-old male patient with a subtotal occlusion of the popliteal artery, with sensory loss in the foot, 17 days after ACLR. Embolectomy and anticoagulant therapy led to full recovery of the peripheral arterial circulation. The sensory loss of the foot also fully recovered. To our knowledge, this is the first case report of an embolus of the popliteal artery after ACLR without relation to graft fixation. A literature review on vascular complications after ACLR is presented.

Sala, H. A. G. M.

2007-01-01

308

Association of peripheral vertical meniscal tears with anterior cruciate ligament tears  

Microsoft Academic Search

Objective  The purpose of this article is to describe a type of meniscal tear seen on magnetic resonance (MR) imaging, the peripheral\\u000a vertical tear, and to determine the prevalence of anterior cruciate ligament (ACL) tears in knees with this type of meniscal\\u000a tear compared to knees with other types of meniscal tears.\\u000a \\u000a \\u000a \\u000a Materials and methods  Following Institutional Review Board approval, a retrospective

Emily N. Vinson; Jeffrey A. Gage; Joe N. Lacy

2008-01-01

309

Partial tear of the anterior cruciate ligament of the knee: injury patterns on MR imaging  

Microsoft Academic Search

Purpose  To describe rupture patterns of partial anterior cruciate ligament (ACL) tears on magnetic resonance (MR) imaging.\\u000a \\u000a \\u000a \\u000a Methods  MR images of 51 patients with a surgically confirmed partial ACL tear were retrospectively and independently interpreted by\\u000a 2 experienced, blinded radiologists. Using previously described MR criteria, ACLs were categorized as follows: complete tear,\\u000a partial tear, isolated anteromedial or posterolateral bundle tear, mucoid degeneration

Pieter Van Dyck; Eline De Smet; Jan Veryser; Valérie Lambrecht; Jan L. Gielen; Filip M. Vanhoenacker; Lieven Dossche; Paul M. Parizel

310

Surgical Treatment of Simultaneous Rupture of the Anterior Cruciate Ligament and the Patellar Tendon.  

PubMed

Although the rupture of the anterior cruciate ligament (ACL) is a common sports injury, a simultaneous rupture of the patellar tendon (PT) is relatively rare. We experienced a case in which a patient simultaneously ruptured the ACL, the medial collateral ligament (MCL), and the PT while sliding during a baseball game. We sutured the PT and MCL during the acute stage, and 7 months later we conducted a double-bundle reconstruction of the ACL. To our knowledge, this is the first report of PT repair using only fiber wire thread, and two-phase double-bundle ACL reconstruction. PMID:23288727

Chiba, Kyohei; Takahashi, Toshiaki; Hino, Kazunori; Watanabe, Seiji; Yamaoka, Gotaro; Shirakata, Haruo; Fujii, Yuko; Miura, Hiromasa

2011-10-01

311

Magnetic resonance imaging of surgically confirmed anterior cruciate ligament graft disruption  

Microsoft Academic Search

Objective  To evaluate previously described primary and secondary MRI signs of disruption to anterior cruciate ligament (ACL) grafts\\u000a in surgically proven cases.\\u000a \\u000a \\u000a \\u000a Materials and methods  We retrospectively analyzed MR images of 48 patients (mean age 29 years) with clinically suspected ACL graft disruption. All\\u000a patients had surgical confirmation of the MRI findings. The reviewers analyzed the cases blinded to the surgical results and

Mark S. Collins; Kenneth P. Unruh; Jeffrey R. Bond; Jayawant N. Mandrekar

2008-01-01

312

Is postural control restored following anterior cruciate ligament reconstruction? A systematic review  

Microsoft Academic Search

Purpose  The aim of this systematic review was to determine whether lower limb postural control is restored in patients following anterior\\u000a cruciate ligament (ACL) reconstruction surgery when compared to healthy controls.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A systematic review was conducted. Electronic databases including Medline, Embase, SPORTDiscus and CINAHL were searched from\\u000a the earliest possible entry to April 2010. Studies that evaluated postural control in patients

Brooke E. Howells; Clare L. Ardern; Kate E. Webster

2011-01-01

313

Current concepts of the management of anterior cruciate ligament injuries in children.  

PubMed

Recent reports have suggested an increase in the number of anterior cruciate ligament (ACL) injuries in children, although their true incidence is unknown. The prognosis of the ACL-deficient knee in young active individuals is poor because of secondary meniscal tears, persistent instability and early-onset osteoarthritis. The aim of surgical reconstruction is to provide stability while avoiding physeal injury. Techniques of reconstruction include transphyseal, extraphyseal or partial physeal sparing procedures. In this paper we review the management of ACL tears in skeletally immature patients. Cite this article: Bone Joint J 2013;95-B:1562-9. PMID:24151280

Al-Hadithy, N; Dodds, A L; Akhtar, K S N; Gupte, C M

2013-11-01

314

An anterior ankle arthroscopic technique for retrograde osteochondral autograft transplantation of posteromedial and central talar dome cartilage defects.  

PubMed

PURPOSE: The purpose of this study was to present an arthroscopic technique for the treatment for posteromedial and central cartilage defects of the talus using anterior arthroscopic portals and without performing a medial malleolar osteotomy. METHODS: Nine fresh cadavers were dissected. Autografts were implanted under arthroscopy using a retrograde osteochondral transplantation system, and their position was estimated using specific angular calibrators and later confirmed by software analysis of two photographs of the disarticulated ankle joint. RESULTS: In eight cases, the congruence between the surrounding articular cartilage and the cartilage of the graft was high, with differences measuring <1 mm. There were no iatrogenic cartilage lesions of the tibial plafond and no fractures of the talus. All the autografts remained stable during full range of motion cycles of the ankle joint. One failure was reported. CONCLUSION: This cadaveric study showed that the retrograde osteochondral autograft transplantation technique in the talus is feasible. It can be used to restore the posteromedial and central talar articular surfaces using conventional ankle arthroscopic instrumentation and anterior arthroscopic portals without resorting to a medial malleolar osteotomy. Further clinical and biomechanical studies are required to prove the efficacy of this technique and its reproducibility in routine clinical practice. PMID:23579227

Wajsfisz, Anthony; Makridis, Konstantinos G; Naji, Omar; Hirsh, Caroline; Boisrenoult, Philippe; Beaufils, Philippe

2013-04-12

315

Management of anterior cruciate ligament rupture in patients aged 40 years and older.  

PubMed

The aim of anterior cruciate ligament (ACL) reconstruction is essentially to restore functional stability of the knee and to allow patients to return to their desired work and activities. While in the young and active population, surgery is often the best therapeutic option after an ACL tear, ACL reconstruction in middle-aged people is rather more controversial due to concerns about a higher complication rate. The purpose of our article is to establish, through a systematic review of the literature, useful decision-making criteria for the management of anterior cruciate ligament rupture in patients aged 40 years and older, guiding surgeons to the most appropriate therapeutic approach. Various reports have shown excellent results of ACL reconstruction in patients over the age of 40 in terms of subjective satisfaction, return to previous activity level, and reduced complication and failure rates. Some even document excellent outcomes in subjects of 50 years and older. Although there are limited high-level studies, data reported in the literature suggest that ACL reconstruction can be successful in appropriately selected, motivated older patients with symptomatic knee instability who want to return to participating in highly demanding sport and recreational activities. Deciding factors are based on occupation, sex, activity level of the subject, amount of time spent performing such highly demanding activities, and presence of associated knee lesions. Physiological age and activity level are more important than chronological age as deciding factors when considering ACL reconstruction. PMID:22075673

Legnani, Claudio; Terzaghi, Clara; Borgo, Enrico; Ventura, Alberto

2011-11-11

316

Serial dilation versus extraction drilling in anterior cruciate ligament reconstruction: a biomechanical study.  

PubMed

The hamstring tendon graft has become increasingly popular in anterior cruciate ligament reconstruction because of low donor-site morbidity. However, the tibial fixation is considered difficult, mainly because of low tibial mineral bone density. Therefore, we tested whether preparation of the tibial tunnel with compaction by serial dilation provided a stronger anchorage of the graft-fixation-device complex than does traditional extraction drilling of the tibial tunnel. In 20 bovine tibiae, the bone tunnels were created with either extraction drilling (group 1) or compaction by serial dilation (group 2). Twenty bovine digital extensor tendons were fixated in the bone tunnel with an Intrafix tibial fastener. The graft-fixation-device complexes were mounted in a hydraulic test machine. The fixation strength was evaluated after cyclic loading. The difference between the serial dilation group and the extraction drilling group ranged from a mean slippage of 0 mm at 70-220 N, to a mean slippage of 0.1 mm at 70-520 N. We found no significant difference in slippage of the graft-fixation-device complex after 1,600 cycles. This study failed to show a significant difference between compaction by serial dilation and extraction drilling of the tibia bone tunnel in anterior cruciate ligament reconstruction. PMID:19784628

Sørensen, O G; Jakobsen, B W; Kold, S; Hansen, T B; Søballe, K

2009-09-26

317

Chronic anterior cruciate ligament deficiency is associated with increased anterior translation of the tibia during the transition from non-weightbearing to weightbearing  

Microsoft Academic Search

Translation of the tibia relative to the femur was measured while a group of subjects with normal knees and group with anterior cruciate ligament (ACL) tears underwent transition from non-weightbearing to weightbearing stance. Subjects were positioned in the Vermont knee laxity device (VKLD) with muscles relaxed and the limb segment and compressive joint load offset (non-weightbearing). A lateral radiograph of

Bruce D. Beynnon; Braden C. Fleming; Ryan Labovitch; Bradford Parsons

2002-01-01

318

Arthroscopic Repair of Meniscal Tears that Extend into the Avascular ZoneA Review of 198 Single and Complex Tears  

Microsoft Academic Search

We assessed the results of 198 meniscal tears that had a major segment in the central avascular region repaired with an arthroscopically assisted inside-out technique. There were 177 patients whose mean age was 28 years. Eighty-two percent were injured during sports, and 71% also required anterior cruciate ligament reconstruction. The menisci were evaluated by clinical examination (180 repairs) a mean

Marc H. Rubman; Frank R. Noyes; Sue D. Barber-Westin

1998-01-01

319

Intercondylar Notch Width Measurement Differences Between African American and White Men and Women With Intact Anterior Cruciate Ligament Knees  

Microsoft Academic Search

Background: A recent report of professional women's basketball found that white European American female players were 6.5 times more likely to tear their anterior cruciate ligament than their nonwhite European American counterparts. African Americans accounted for 95% of the nonwhite European American group.Hypothesis: African American men and women have wider intercondylar notches than white men and women. Study Design: Cohort

K. Donald Shelbourne; Tinker Gray; Rodney W. Benner

2007-01-01

320

Return of Motion After Simultaneous Repair of Displaced Bucket-Handle Meniscal Tears and Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Summary: Patients with displaced bucket-handle (DBH) meniscal tears in anterior cruciate ligament (ACL)-deficient knees are prone to flexion contracture following meniscal repair and simultaneous ACL reconstruction. It has been suggested that ACL reconstruction be delayed until full range of motion has returned after the meniscal repair. A retrospective analysis was performed comparing the return of extension in patients undergoing simultaneous

John G. Costouros; Giovanni R. Raineri; W. Dilworth Cannon

1999-01-01

321

Tissue Engineering of the Anterior Cruciate Ligament: The Viscoelastic Behavior and Cell Viability of a Novel Braid–Twist Scaffold  

Microsoft Academic Search

The anterior cruciate ligament (ACL) is the most commonly injured ligament of the knee; it also contributes to normal knee function and stability. Due to its poor healing potential severe ACL damage requires surgical intervention, ranging from suturing to complete replacement. Current ACL replacements have a host of limitations that prevent their extensive use. Investigators have begun to utilize tissue-engineering

Joseph W. Freeman; Mia D. Woods; Damond A. Cromer; Lee D. Wright; Cato T. Laurencin

2009-01-01

322

Acutely repaired proximal anterior cruciate ligament ruptures in sheep – by augmentation improved stability and reduction of cartilage damage  

Microsoft Academic Search

The aim of this study was to evaluate the healing capacity of proximal anterior cruciate ligament (ACL) ruptures following primary repair with and without a bioresorbable augmentation. The ACL was transected at the femoral origin in the right knee joint of 24 sheep. The ACL was repaired in eight sheep (group B) without, and in eight sheep (group C) with

M RICHTER; L DURSELEN; A IGNATIUS; F MISSLER; L CLAES; H KIEFER

1997-01-01

323

Primary repair plus intra-articular iliotibial band augmentation in the treatment of an acute anterior cruciate ligament rupture  

Microsoft Academic Search

Between September 1987 and November 1989, we treated 90 consecutive patients with an acute anterior cruciate ligament (ACL) rupture with the multiple suture technique and iliotibial band augmentation. Seventy of these patients were re-examined 2 to 5 years after the operation (mean 3.5 years), the examination consisting of a questionnaire, clinical examination, laxity tests with the KSS machine (Acufex), radiological

A. Natri; P. Kannus; M. Järvinen

1996-01-01

324

Patterns of Gene Expression in a Rabbit Partial Anterior Cruciate Ligament Transection ModelThe Potential Role of Mechanical Forces  

Microsoft Academic Search

Background: The inconsistency in healing after anterior cruciate ligament (ACL) repair has been attributed to ACL fibroblast cellular metabolism, lack of a sufficient vascular supply, and the inability to form a scar or scaffold after ligament rupture because of the uniqueness of the intra-articular environment.Hypotheses: (1) Stress deprivation in the surgically transected ACL will increase matrix metalloproteinase (MMP) and alpha

Erik Attia; Haydee Brown; Ross Henshaw; Sheela George; Jo A. Hannafin

2010-01-01

325

High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury  

Microsoft Academic Search

Objective. To determine the prevalence of radio- graphic knee osteoarthritis (OA) as well as knee-related symptoms and functional limitations in female soccer players 12 years after an anterior cruciate ligament (ACL) injury. Methods. Female soccer players who sustained an ACL injury 12 years earlier were examined with stan- dardized weight-bearing knee radiography and 2 self- administered patient questionnaires, the Knee

L. S. Lohmander; M. Englund; H. Roos

2004-01-01

326

Extension block secondary to partial anterior cruciate ligament tear on the femoral attachment of the posterolateral bundle  

Microsoft Academic Search

Purpose: The purpose of this investigation was to prove that a partial tear of the anterior cruciate ligament (ACL) at the femoral attachment of the posterolateral bundle can result in mechanical knee locking and trigger the injury mechanism of an isolated ACL injury. Type of Study: Case series. Methods: From February 1993 through June 1999, 19 cases of knee locking

Churl-Hong Chun; Byoung-Chang Lee; Jae-Hyun Yang

2002-01-01

327

A stochastic biomechanical model for risk and risk factors of non-contact anterior cruciate ligament injuries  

Microsoft Academic Search

Gender has been identified as a risk factor for non-contact anterior cruciate ligament (ACL) injuries. Although some possible biomechanical risk factors underlying the gender differences in the risk for non-contact ACL injuries have been identified, they have not been quantitatively confirmed yet because of the descriptive nature of the traditional epidemiological methods. The purpose of this study was to validate

Cheng-Feng Lin; Michael Gross; Chuanshu Ji; Darin Padua; Paul Weinhold; William E. Garrett; Bing Yu

2009-01-01

328

The COL5A1 Gene Is Associated With Increased Risk of Anterior Cruciate Ligament Ruptures in Female Participants  

Microsoft Academic Search

Background: Anterior cruciate ligament ruptures, especially to young female athletes, are a cause of major concern in the sports medicine fraternity. The major structural constituents of ligaments are collagens, specifically types I and V. Recently, the gene that encodes for the ?1 chain of type I collagen (COL1A1 ) has been shown to be associated with an increased risk of

Michael Posthumus; Alison V. September; Dion OCuinneagain; Willem van der Merwe; Martin P. Schwellnus; Malcolm Collins

2009-01-01

329

Comparison of anterior cruciate ligament reconstruction in male and female athletes using the patellar tendon and hamstring autografts  

Microsoft Academic Search

Despite the higher incidence of anterior cruciate ligament (ACL) injuries in female than in male athletes few authors have studied the effects of gender on the outcome of ACL reconstruction. This prospective study compared the results of ACL reconstruction using the patellar tendon and hamstring techniques in men and women. We prospectively followed 80 comparable athletes (46 males, 32 females)

Alberto Gobbi; Marcin Domzalski; Jose Pascual

2004-01-01

330

Shoe-Surface Friction Influences Movement Strategies During a Sidestep Cutting TaskImplications for Anterior Cruciate Ligament Injury Risk  

Microsoft Academic Search

Background: Increasing the coefficient of friction of the shoe-surface interaction has been shown to lead to increased incidence of anterior cruciate ligament (ACL) injuries, but the causes for this increase are unknown. Previous studies indicate that specific biomechanical measures during landing are associated with an increased risk for ACL injury.Hypothesis: At foot contact during a sidestep cutting task, subjects use

Ariel V. Dowling; Stefano Corazza; Ajit M. W. Chaudhari; Thomas P. Andriacchi

2010-01-01

331

Comparison of intravenous pethidine infusion with ‘3 in 1’ lumbar plexus block after anterior cruciate ligament reconstruction  

Microsoft Academic Search

We studied 104 patients undergoing primary anterior cruciate ligament reconstruction who were prospectively randomized into receiving either an intravenous pethidine infusion or a continuous bupivicaine infusion to the lumbar plexus via the femoral sheath, for postoperative analgesia. No difference was found between the two methods in terms of their analgesic effect (P > 0.1) and both were well tolerated by

RDA Dodds; PJ McMeniman; R Krippner; PT Myers

1995-01-01

332

The effects of geometry and fiber bundle orientation on the finite element modeling of the anterior cruciate ligament  

Microsoft Academic Search

The anterior cruciate ligament (ACL) has irregular geometry and spirally oriented fiber bundle organization, which are closely related to its physiological function. In previous finite element (FE) models, however, these two features are neglected due to the difficulty of obtaining its complex geometry and spiral fiber bundle orientation. Based on a previously developed and validated FE model, this study performed

Xiaoyan Zhang; Changfu Wu; Guotai Jiang; Savio L. Y. Woo

2008-01-01

333

Reconstruction of the anterior cruciate ligament in the dogComparison of results obtained with three different porous synthetic materials  

Microsoft Academic Search

The anterior cruciate ligaments in 17 knees of 12 mongrel dogs were replaced with one of three porous minimally reactive prosthetic (synthetic) materials. The results show that while the porous materials support the ingrowth of fibrous tissue from the bone of the dog's knee, fatigue failure occurred before sufficient fibrous tissue was incorporated to reconstitute a functional ligament. Further laboratory

John F. Meyers; William A. Grana; Peggy A. Lesker

1979-01-01

334

Incidence of Anterior Cruciate Ligament Injuries Among Elite Ballet and Modern DancersA 5-year Prospective Study  

Microsoft Academic Search

Background: Ballet and modern dance are jump-intensive activities, but little is known about the incidence of anterior cruciate ligament (ACL) injuries among dancers.Hypothesis: Rigorous jump and balance training has been shown in some prospective studies to significantly reduce ACL injury rates among athletes. Dancers advance to the professional level only after having achieved virtuosic jump and balance technique. Therefore, dancers

Marijeanne Liederbach; Faye E. Dilgen; Donald J. Rose

2008-01-01

335

Reconstruction of the anterior cruciate ligament with freeze dried fascia lata allografts in dogsA preliminary report  

Microsoft Academic Search

In 16 adult dogs the anterior cruciate ligament (ACL) was transected and then reconstructed using freeze dried fascia lata allografts. Eight of the dogs had the intraarticular graft passed through drill holes in the tibia and femur, while in the other eight dogs the graft was passed through a drill hole in the tibia and routed \\

Ralph J. Curtis; Jesse C. Delee; David J. Drez

1985-01-01

336

Factors affecting return to sports after anterior cruciate ligament reconstruction with patellar tendon and hamstring graft: a prospective clinical investigation  

Microsoft Academic Search

In athletes, anterior cruciate ligament (ACL) reconstruction is recommended after injury to restore the normal knee function and allow subsequent return to sport. Successful ACL reconstruction with patellar tendon (PT) and hamstring tendon (HT) grafts combined with a well-structured rehabilitation program could bring athletes back to their previous level of sport activities. We prospectively followed-up 100 athletes who underwent ACL

Alberto Gobbi; Ramces Francisco

2006-01-01

337

Prediction of Chronicity of Anterior Cruciate Ligament Tear Using MRI Findings  

PubMed Central

Background The estimation of anterior cruciate ligament (ACL) tear is required in certain cases involving legal and financial administration, such as the worker's compensation and/or insurance. The aim of this study is to propose and evaluate a quantitative evaluation instrument to estimate the chronicity of the ACL tear, based on the four magnetic resonance imaging (MRI) findings. Methods One hundred and fifty one cases of complete ACL tear confirmed by arthroscopy were divided into 4 groups according to the time from ACL injury to MRI acquisition: acute (< 6 weeks), subacute (6 weeks to 3 months), intermediate (3 months to 1 year), and chronic (> 1 year). The four MRI findings including ACL morphology, joint effusion, posterior cruciate ligament angle, and bone bruise were analyzed for temporal changes among the 4 groups. Binary logistic regression equations were formulated using the MRI findings to estimate the chronicity of ACL tear in a quantitative manner, and the accuracy of the formulated regression equations was evaluated. Results The four MRI findings showed substantial temporal correlation with the time-limits of ACL injury to be included in the estimation model. Three predictive binary logistic equations estimated the probability of the ACL injury for the three cutoff time-limits of 6 weeks, 3 months, and 1 year with accuracies of 82.1%, 89.4%, and 89.4%, respectively. Conclusions A series of predictive logistic equations were formulated to estimate the chronicity of ACL tear using 4 MRI findings with chronological significance.

Yoon, Jong Pil; Yoo, Jae Ho; Chang, Chong Bum; Kim, Sung Ju; Choi, Ja Young; Yi, Jae Hyuck

2013-01-01

338

Cartilage Pressure Distributions Provide a Footprint to Define Female Anterior Cruciate Ligament Injury Mechanisms  

PubMed Central

Background Bone bruises located on the lateral femoral condyle and posterolateral tibia are commonly associated with anterior cruciate ligament (ACL) injuries and may contribute to the high risk for knee osteoarthritis after ACL injury. The resultant footprint (location) of a bone bruise after ACL injury provides evidence of the inciting injury mechanism. Purpose/Hypothesis (1) To analyze tibial and femoral articular cartilage pressure distributions during normal landing and injury simulations, and (2) to evaluate ACL strains for conditions that lead to articular cartilage pressure distributions similar to bone bruise patterns associated with ACL injury. The hypothesis was that combined knee abduction and anterior tibial translation injury simulations would demonstrate peak articular cartilage pressure distributions in the lateral femoral condyle and posterolateral tibia. The corollary hypothesis was that combined knee abduction and anterior tibial translation injury conditions would result in the highest ACL strains. Study Design Descriptive laboratory study. Methods Prospective biomechanical data from athletes who subsequently suffered ACL injuries after testing (n = 9) and uninjured teammates (n = 390) were used as baseline input data for finite element model comparisons. Results Peak articular pressures that occurred on the posterolateral tibia and lateral femoral condyle were demonstrated for injury conditions that had a baseline knee abduction angle of 5°. Combined planar injury conditions of abduction/anterior tibial translation, anterior tibial translation/internal tibial rotation, or anterior tibial translation/external tibial rotation or isolated anterior tibial translation, external tibial rotation, or internal tibial rotation resulted in peak pressures in the posterolateral tibia and lateral femur. The highest ACL strains occurred during the combined abduction/anterior tibial translation condition in the group that had a baseline knee abduction angle of 5°. Conclusion The results of this study support a valgus collapse as the major ACL injury mechanism that results from tibial abduction rotations combined with anterior tibial translation or external or internal tibial rotations. Clinical Relevance Reduction of large multiplanar knee motions that include abduction, anterior translation, and internal/external tibial motions may reduce the risk for ACL injuries and associated bone bruises. In particular, prevention of an abduction knee posture during initial contact of the foot with the ground may help prevent ACL injury.

Quatman, Carmen E.; Kiapour, Ali; Myer, Gregory D.; Ford, Kevin R.; Demetropoulos, Constantine K.; Goel, Vijay K.; Hewett, Timothy E.

2012-01-01

339

Does chronic medial collateral ligament laxity influence the outcome of anterior cruciate ligament reconstruction?: a prospective evaluation with a minimum three-year follow-up.  

PubMed

We have shown in a previous study that patients with combined lesions of the anterior cruciate (ACL) and medial collateral ligaments (MCL) had similar anteroposterior (AP) but greater valgus laxity at 30° after reconstruction of the ACL when compared with patients who had undergone reconstruction of an isolated ACL injury. The present study investigated the same cohort of patients after a minimum of three years to evaluate whether the residual valgus laxity led to a poorer clinical outcome. Each patient had undergone an arthroscopic double-bundle ACL reconstruction using a semitendinosus-gracilis graft. In the combined ACL/MCL injury group, the grade II medial collateral ligament injury was not treated. At follow-up, AP laxity was measured using a KT-2000 arthrometer, while valgus laxity was evaluated with Telos valgus stress radiographs and compared with the uninjured knee. We evaluated clinical outcome scores, muscle girth and time to return to activities for the two groups. Valgus stress radiographs showed statistically significant greater mean medial joint opening in the reconstructed compared with the uninjured knees (1.7 mm (SD 0.9) versus 0.9 mm (SD 0.7), respectively, p = 0.013), while no statistically significant difference was found between the AP laxity and the other clinical parameters. Our results show that the residual valgus laxity does not affect AP laxity significantly at a minimum follow up of three years, suggesting that no additional surgical procedure is needed for the medial collateral ligament in combined lesions. PMID:21768629

Zaffagnini, S; Bonanzinga, T; Marcheggiani Muccioli, G M; Giordano, G; Bruni, D; Bignozzi, S; Lopomo, N; Marcacci, M

2011-08-01

340

Self-Protective Changes in Athletic Identity Following Anterior Cruciate Ligament Reconstruction  

PubMed Central

Objectives This study was designed to examine the possibility of self-protective changes in athletic identity (AI) being initiated after the occurrence of a severe injury. Method People (72 men and 36 women) undergoing anterior cruciate ligament (ACL) surgery and rehabilitation were asked to complete a measure of AI prior to surgery and measures of AI and rehabilitation progress at approximately 6, 12, and 24 months after surgery. Results A repeated-measures ANCOVA controlling for age and gender indicated that AI decreased significantly across the 24-month period following surgery, with the most substantial decline occurring between 6 and 12 months postsurgery. Significantly greater decreases in AI were observed among participants whose rehabilitation progress was slowest from 6 to 12 months postsurgery. Conclusions The findings suggest that some participants reduced their identification with the athlete role in response to the threat to a positive self-image posed by their ACL injuries and the difficulties they encountered in postoperative rehabilitation.

Brewer, Britton W.; Cornelius, Allen E.

2009-01-01

341

Anterior Cruciate Ligament Tear in an Athlete: Does Increased Heel Loading Contribute to ACL Rupture?  

PubMed Central

Rupture to the anterior cruciate ligament is a common athletic injury in American football. The lower extremity biomechanics related to increased ACL injury risk are not completely understood. However, foot landing has been purported to be a significant contributing factor to the ACL injury mechanism. In this case report, information is presented on an athlete previously tested for in-shoe loading patterns on artificial turf and subsequently went on to non-contact ACL rupture on the same surface. This case report describes the specific findings in a study participant who suffered an ACL rupture after testing and suggests that flatfoot tendency in running and cutting maneuvers might lead to an increased risk of ACL injury.

Burkhart, Bradd; Ford, Kevin R.; Heidt, Robert S.; Hewett, Timothy E.

2008-01-01

342

Anterior cruciate ligament integrity in osteoarthritis of the knee in patients undergoing total knee replacement  

PubMed Central

Background Anterior cruciate ligament (ACL) rupture has been implicated in the development of knee osteoarthritis (OA). This study aimed at determining the incidence of prior ACL deficiency in patients undergoing total knee replacement (TKR), the effect of prior ACL deficiency on function and the macroscopic and microscopic appearance of the ligament. Materials and methods A total of 95 patients undergoing elective TKR for OA were recruited. Pre-operative knee assessment included questionnaires and KT1000 testing. The ACL was examined macroscopically at TKR in all patients, and 10 ACL specimens were examined histologically. Results The ACL was absent in 12% of the patients. There was no significant correlation between the pre-operative assessment or function and operative findings. The ACL samples all demonstrated degenerative change of varying severities. Conclusion ACL deficiency is uncommon in patients undergoing TKR for OA, and does not worsen pre-operative function.

Douglas, M. J. M.; Hutchison, J. D.

2010-01-01

343

Differences among mechanoreceptors in healthy and injured anterior cruciate ligaments and their clinical importance  

PubMed Central

Summary Mechanoreceptors in an intact Anterior Cruciate Ligament (ACL) contribute towards functional stability of the knee joint. Injury to the ACL not only causes mechanical instability, but also leads to a disturbance in the neuromuscular control of the injured knee due to loss or damage to mechanoreceptors. ACL reconstruction restores proprioceptive potential of the knee to some extent, but the results vary. Although the remnant ACL contains residual mechanoreceptors, the number and functionality of these receptors is dependent, to some extent, on the physical characteristics of the remnant and duration of injury. Remnants, especially that adherent to the PCL, may actually act as a possible source of reinnervation of the graft. These remnants are worth preserving during ACL reconstruction and can play an important role in restoration of proprioception of knee following ACL reconstruction.

Dhillon, Mandeep Sing; Bali, Kamal; Prabhakar, Sharad

2012-01-01

344

Osteopathic manipulative treatment of a 27-year-old man after anterior cruciate ligament reconstruction.  

PubMed

Increasing instability of the knee developed in a 27-year-old man who had torn his anterior cruciate ligament (ACL) approximately 10 years prior to surgical intervention. After initial conservative treatment, including use of a functional brace for activity, the patient opted for surgical reconstruction with a patellar tendon graft. One of the authors conducted three preoperative examinations to assess the condition of the patient's musculoskeletal system. These manual examinations included findings of somatic dysfunction in the lumbo-pelvic region. In addition, there was extension of muscular tension from the injured left knee and ankle into the lower thorax and ribs 6 through 9. During the postoperative rehabilitation process, examination at regular intervals included documentation of somatic dysfunction and osteopathic manipulative treatment (OMT). Following ACL reconstruction and OMT, the patient showed increasingly stable mobility in the lumbopelvic region. Furthermore, episodic new dysfunctions readily resolved with OMT. The patient returned to his regular sports activities 6 months after surgery. PMID:16790541

Gugel, Mark R; Johnston, William L

2006-06-01

345

Most British Surgeons Would Consider Using a Tissue-Engineered Anterior Cruciate Ligament: A Questionnaire Study  

PubMed Central

Donor site morbidity, poor graft site integration, and incorrect mechanical performance are all common problems associated with autografts for anterior cruciate ligament (ACL) reconstructions. A tissue-engineered (TE) ligament has the potential to overcome these problems. We produced an online questionnaire relating to tissue engineering of the ACL to obtain input from practising clinicians who currently manage these injuries. 300 British orthopaedic surgeons specialising in knee surgery and soft tissue injury were invited to participate. 86% of surgeons would consider using a TE ACL if it were an option, provided that it showed biological and mechanical success, if it significantly improved the patient satisfaction (63%) or shortened surgical time (62%). 76% felt that using a TE ACL would be more appropriate than a patellar tendon, hamstring, or quadriceps autograft. Overall, most surgeons would be prepared to use a TE ACL if it were an improvement over the current techniques.

Rathbone, Sarah; Maffulli, Nicola; Cartmell, Sarah H.

2012-01-01

346

Anterior cruciate ligament surgery: optimize return to activity and minimize risk of a second injury.  

PubMed

A torn anterior cruciate ligament (ACL) can be a devastating injury for active individuals and athletes. After the injury, some individuals will recover with a good rehabilitation program and will not need surgery. However, if the injured knee feels like it gives way or if the knee is not stable, surgery to "reconstruct" the ACL may be required. After surgery, returning to preinjury activities can be challenging. In a review article published in the November 2013 issue of JOSPT, the authors' findings provide new insight and research-based strategies to help enhance performance and limit the risk of reinjury after ACL surgery. J Orthop Sports Phys Ther 2013;43(11):793. doi:10.2519/jospt.2013.0506. PMID:24175621

2013-11-01

347

Subjective Evaluation of Function Following Moderately Accelerated Rehabilitation of Anterior Cruciate Ligament Reconstructed Knees  

PubMed Central

Rehabilitation protocols following anterior cruciate ligament reconstructions have become increasingly aggressive in the past several years, preparing the patient to return to sport activities within 4 to 6 months. In 1989, we initiated a moderately accelerated protocol and were interested in the long-term effects of early weight bearing, immediate full motion, early incorporation of closed chain activities, and early return to sport. We received responses from 58 of 180 patients surveyed. All had undergone a bone-patellar tendon-bone autograft reconstruction procedure 12 to 21 months prior and had followed the rehabilitation protocol described. Results of the Lysholm Knee Scoring Scale and a questionnaire regarding preinjury and postinjury activity levels, pain and stability ratings, and current activity indicated that the majority of these patients had returned to sport and recreation and were participating at levels of moderate to high intensity with little or no difficulty. ImagesINGINGINGING

Draper, Vanessa; Ladd, Chip

1993-01-01

348

Failure locus of the anterior cruciate ligament: 3D finite element analysis.  

PubMed

Anterior cruciate ligament (ACL) disruption is a common injury that is detrimental to an athlete's quality of life. Determining the mechanisms that cause ACL injury is important in order to develop proper interventions. A failure locus defined as various combinations of loadings and movements, internal/external rotation of femur and valgus and varus moments at a 25(o) knee flexion angle leading to ACL failure was obtained. The results indicated that varus and valgus movements were more dominant to the ACL injury than femoral rotation. Also, Von Mises stress in the lateral tibial cartilage during the valgus ACL injury mechanism was 83% greater than that of the medial cartilage during the varus mechanism of ACL injury. The results of this study could be used to develop training programmes focused on the avoidance of the described combination of movements which may lead to ACL injury. PMID:21590555

Homyk, Andrew; Orsi, Alexander; Wibby, Story; Yang, Nicholas; Nayeb-Hashemi, Hamid; Canavan, Paul K

2011-05-23

349

Mycobacterium fortuitum infection after anterior cruciate ligament reconstruction using a polylactic acid bioabsorbable screw: Case report.  

PubMed

We report a case of pretibial sinus and abscess after anterior cruciate ligament reconstruction using a polylactic acid tricalcium phosphate bioabsorbable screw for tibial fixation. Mycobacterium fortuitum was identified as the pathogen after specific mycobacterial cultures were obtained from operative specimens. M. fortuitum is a known but rare cause of periprosthetic infection. Diagnosis is often delayed as routine microbiological cultures do not utilise specific culture requirements for mycobacterial growth. There have been several reports in the literature of sterile abscesses associated with bioabsorbable screws. To our knowledge, this is the first case report of a non-tuberculous mycobacterial infection associated with a bioabsorbable implant. This case illustrates that post-operative Mycobacterium infection can occur as a complication of ACL reconstruction with bioabsorbable screw fixation and should be considered in the differential diagnosis of post-operative periprosthetic infection. PMID:19744856

Oh, Horng Lii; Chen, Darren B; Seeto, Bradley G; Macdessi, Samuel J

2009-09-09

350

Meniscectomy for tears of the meniscus combined with rupture of the anterior cruciate ligament.  

PubMed

A group of 40 patients with unstable knees due to a combination of a meniscal tear with a rupture of the anterior cruciate ligament was studied to assess the effects of treatment by meniscectomy alone. The results were assessed both subjectively and objectively, but emphasis was placed on the symptoms rather than the physical signs of instability. Meniscectomy alone cured the symptoms of instability in 22 of the patients and a further eight required no further surgical treatment; bucket-handle tears were associated with a good result and posterior-horn tears with a poor result. The remaining 10 patients later underwent an additional procedure to reconstruct the ligament because of persisting symptoms. It was concluded that in patients with this combined lesion the torn meniscus should be dealt with first. In young patients with a posterior-horn tear it would be justifiable to perform a ligamentous reconstruction at the same time as the meniscectomy. PMID:6874708

Paterson, F W; Trickey, E L

1983-08-01

351

Ligament Tissue Engineering and Its Potential Role in Anterior Cruciate Ligament Reconstruction  

PubMed Central

Tissue engineering is an emerging discipline that combines the principle of science and engineering. It offers an unlimited source of natural tissue substitutes and by using appropriate cells, biomimetic scaffolds, and advanced bioreactors, it is possible that tissue engineering could be implemented in the repair and regeneration of tissue such as bone, cartilage, tendon, and ligament. Whilst repair and regeneration of ligament tissue has been demonstrated in animal studies, further research is needed to improve the biomechanical properties of the engineered ligament if it is to play an important part in the future of human ligament reconstruction surgery. We evaluate the current literature on ligament tissue engineering and its role in anterior cruciate ligament reconstruction.

Yates, E. W.; Rupani, A.; Foley, G. T.; Khan, W. S.; Cartmell, S.; Anand, S. J.

2012-01-01

352

Anterior cruciate ligament graft tensioning. Is the maximal sustained one-handed pull technique reproducible?  

PubMed Central

Background Tensioning of anterior cruciate ligament (ACL) reconstruction grafts affects the clinical outcome of the procedure. As yet, no consensus has been reached regarding the optimum initial tension in an ACL graft. Most surgeons rely on the maximal sustained one-handed pull technique for graft tension. We aim to determine if this technique is reproducible from patient to patient. Findings We created a device to simulate ACL reconstruction surgery using Ilizarov components and porcine flexor tendons. Six experienced ACL reconstruction surgeons volunteered to tension porcine grafts using the device to see if they could produce a consistent tension. None of the surgeons involved were able to accurately reproduce graft tension over a series of repeat trials. Conclusions We conclude that the maximal sustained one-handed pull technique of ACL graft tensioning is not reproducible from trial to trial. We also conclude that the initial tension placed on an ACL graft varies from surgeon to surgeon.

2011-01-01

353

Three-Dimensional Anatomic Evaluation of the Anterior Cruciate Ligament for Planning Reconstruction  

PubMed Central

Anatomic study related to the anterior cruciate ligament (ACL) reconstruction surgery has been developed in accordance with the progress of imaging technology. Advances in imaging techniques, especially the move from two-dimensional (2D) to three-dimensional (3D) image analysis, substantially contribute to anatomic understanding and its application to advanced ACL reconstruction surgery. This paper introduces previous research about image analysis of the ACL anatomy and its application to ACL reconstruction surgery. Crucial bony landmarks for the accurate placement of the ACL graft can be identified by 3D imaging technique. Additionally, 3D-CT analysis of the ACL insertion site anatomy provides better and more consistent evaluation than conventional “clock-face” reference and roentgenologic quadrant method. Since the human anatomy has a complex three-dimensional structure, further anatomic research using three-dimensional imaging analysis and its clinical application by navigation system or other technologies is warranted for the improvement of the ACL reconstruction.

Hoshino, Yuichi; Kim, Donghwi; Fu, Freddie H.

2012-01-01

354

Task based rehabilitation protocol for elite athletes following Anterior Cruciate ligament reconstruction: a clinical commentary.  

PubMed

Anterior Cruciate ligament (ACL) injuries are one of the most common and devastating knee injuries sustained whilst participating in sport. ACL reconstruction (ACLR) remains the standard approach for athletes who aim to return to high level sporting activities but the outcome from surgery is not assured. Secondary morbidities and an inability to return to the same competitive level are common following ACLR. One factor which might be linked to these sub-optimal outcomes may be a failure to have clearly defined performance criteria for return to activity and sport. This paper presents a commentary describing a structured return to sport rehabilitation protocol for athletes following ACLR. The protocol was developed from synthesis of the available literature and consensus of physiotherapists and strength and conditioning coaches based in the home country Institute of Sports within the United Kingdom. PMID:24016398

Herrington, Lee; Myer, Gregory; Horsley, Ian

2013-08-28

355

Early knee motion after open and arthroscopic anterior cruciate ligament reconstruction  

Microsoft Academic Search

The hypothesis proposed in this study was that the initiation of active and passive knee motion within 48 hours of major intraarticular knee ligament surgery would not have the deleterious effects of increasing knee effusion, hemarthrosis, periarticular soft tissue edema, and swelling.We conducted a prospective study with randomized assignment of 18 patients into two groups: 9 patients in the \\

Frank R. Noyes; Robert E. Mangine; Sue Barber

1987-01-01

356

Arthroscopically assisted meniscal allograft transplantation with and without combined anterior cruciate ligament reconstruction  

Microsoft Academic Search

The menisci provide a vital role in load transmission across the knee joint as well as contribute to knee stability, particularly in the ACL-deficient knee. Loss of the meniscus, in part or in total, significantly alters joint function and predisposes the articular cartilage to degenerative changes, which has been well documented both clinically and radiographically. This study examined clinical and

Erol A. Yoldas; Jon K. Sekiya; James J. Irrgang; Freddie H. Fu; Christopher D. Harner

2003-01-01

357

Anterior Cruciate Ligament Insertions on the Tibia and Femur and Their Relationships to Critical Bony Landmarks Using High-Resolution Volume-Rendering Computed Tomography  

Microsoft Academic Search

Background: Controversy exists regarding the locations of the anterior cruciate ligament insertions on the femur and tibia and visualization of these insertions during surgical reconstruction.Hypothesis: Anatomical insertions of the anterior cruciate ligament have relationships to bony landmarks of the tibia and femur.Study Design: Descriptive laboratory study.Methods: Eight cadaveric knees were scanned by computed tomography, reconstructed 3-dimensionally, and examined from simulated

Mark L. Purnell; Andrew I. Larson; William Clancy

2008-01-01

358

Cell survival following bone-anterior cruciate ligament-bone allograft transplantation: DNA fingerprints, segregation, and collagen morphological analysis of multiple markers in the canine model  

Microsoft Academic Search

Bone-anterior cruciate ligament-bone allograft transplantation has become recognized as a potential solution to reconstruction\\u000a of the anterior cruciate ligament (ACL). The purpose of this study was to determine the time-dependent fibrocyte donor cell\\u000a survival rate after cryopreserved bone-ACL-bone allograft transplantation. Additionally, bony incorporation of the pediculated\\u000a bone plugs was examined. The ability to successfully transplant allogenous ACL fibrocytes and have

M. J. Goertzen; J. Buitkamp; H. Clahsen; M. Möllmann

1998-01-01

359

A Prospective, Randomized Comparison of Semitendinosus and Gracilis Tendon Versus Patellar Tendon Autografts for Anterior Cruciate Ligament ReconstructionFive-Year Follow-Up  

Microsoft Academic Search

Background: There are still controversies about graft selection for primary anterior cruciate ligament reconstruction. Prospective randomized long-term studies are needed to determine the differences between the materials.Hypothesis: Five years after anterior cruciate ligament reconstruction, there is a difference between hamstring and patellar tendon grafts in development of degenerative knee joint disease.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: From

Matjaz Sajovic; Vilibald Vengust; Radko Komadina; Rok Tavcar; Katja Skaza

2006-01-01

360

Results of Transphyseal Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Autograft in Tanner Stage 3 or 4 Adolescents with Clearly Open Growth Plates  

Microsoft Academic Search

Background: Drilling across the physes for intra-articular anterior cruciate ligament reconstruction is considered risky for skeletally immature patients.Hypothesis: Skeletally immature patients with clearly open growth plates can safely undergo intra-articular anterior cruciate ligament reconstruction with patellar tendon autograft without suffering growth plate disturbance.Study Design: Retrospective review of prospectively collected data.Methods: Surgery involved drilling tunnels through the tibial and femoral physes,

K. Donald Shelbourne; Tinker Gray; Bryan V. Wiley

2004-01-01

361

Bone tunnel enlargement after anterior cruciate ligament reconstruction using hamstring tendons.  

PubMed

We retrospectively reviewed 87 anterior cruciate ligament reconstructions using autogenous hamstring tendons with the Endobutton technique to investigate the relationship between bone tunnel enlargement and clinical outcome and to identify factors that contribute to the enlargement. The clinical outcome was evaluated using the Lysholm score and KT-1000 arthrometer. The location of the femoral tunnel with respect to Blumensaat's line, the tibial tunnel with respect to the tibial plateau, and the angle between the femoral tunnel and Blumensaat's line (femoral tunnel angle) were measured. Bone tunnel enlargement was observed in 32 patients (37%). Enlargement occurred in 22 of the femoral tunnels and 26 of the tibial tunnels. Enlargement of both tunnels occurred in 16 knees. There was no statistical difference in Lysholm scores or KT-1000 arthrometer measurements between the enlarged group and the unenlarged group. The femoral tunnel was placed more anteriorly in the enlarged femoral tunnel group than in the unenlarged femoral tunnel group. The tibial tunnel was placed more anteriorly in the enlarged tibial tunnel group than in the unenlarged tibial tunnel group. The femoral tunnel angle was significantly smaller in the enlarged femoral tunnel group than in the femoral unenlarged group. Gender, patient age, intraoperative isometricity, and graft size were not significant factors. Bone tunnel enlargement was not correlated with the clinical outcome measures. We conclude that the main factor associated with tunnel enlargement are the locations and angles of the tunnels. The windshield-wiper motion of the graft may be enhanced by changing tension in the graft due to tunnel malposition. An acute femoral tunnel angle may increase the mechanical stress on the anterior margin of the femoral tunnel. PMID:11522075

Segawa, H; Omori, G; Tomita, S; Koga, Y

2001-07-01

362

Impact of Partial and complete rupture of anterior cruciate ligament on medial meniscus: A cadavaric study  

PubMed Central

Background: The clinical relationship between medial meniscus tear and anterior cruciate ligament (ACL) rupture has been well documented. However, the mechanism of this clinical phenomenon is not exactly explained. Our aim is to investigate the biomechanical impact of partial and complete ACL rupture on different parts of medial meniscus. Materials and Methods: Twelve fresh human cadaveric knee specimens were divided into four groups: ACL intact (ACL-I), anteromedial bundle transection (AMB-T), posterolateral bundle transection (PLB-T), and ACL complete transection (ACL-T) group. Strain on the anterior horn, body part, and posterior horn of medial meniscus were measured under 200 N axial compressive tibial load at 0°, 30°, 60°, and 90° of knee flexion, respectively. Results: Compared with the control group (ACL-I), the ACL-T group had a higher strain on whole medial meniscus at 0°, 60°, and 90° of flexion. But at 30°, it had a higher strain on posterior horn of meniscus only. As to PLB-T group, strain on whole meniscus increased at full extension, while strain increased on posterior horn at 30° and on body of meniscus at 60°. However, AMB-T only brought about higher strain at 60° of flexion on body and posterior horn of meniscus. Conclusions: Similar to complete rupture, partial rupture of ACL can also trigger strain concentration on medial meniscus, especially posterior horn, which may be a more critical reason for meniscus injury associated with chronic ACL deficiency.

Jiang, Wei; Gao, Shu-guang; Li, Kang-hua; Luo, Ling; Li, Yu-sheng; Luo, Wei; Lei, Guang-hua

2012-01-01

363

The effect of graft choice on functional outcome in anterior cruciate ligament reconstruction.  

PubMed

A prospective, randomised, 5-year follow-up study was designed to compare the functional results between patellar tendon and hamstring tendon autografts after anterior cruciate ligament reconstruction. Primary reconstruction was performed in 32 patients using the central third of the patellar ligament and in 32 patients using double-looped semitendinosus and gracilis tendons. All reconstructions were performed by a single surgeon, with identical surgical technique and rehabilitation protocol. Of the total 64 patients in the study, 54 (85%) were available for the 5-year follow-up. No statistically significant differences were seen with respect to Lysholm score, International Knee Documentation Committee (IKDC) classification, clinical and KT-2000 arthrometer laxity testing, single-legged hop test and anterior knee pain. Graft rupture occurred in two patients (8%) in the patellar tendon group and in two patients (7%) in the hamstring tendon group; 23 patients (88%) in the patellar tendon group and 23 patients (82%) in the hamstring tendon group returned to their pre-injury activity level. Good subjective outcome and stability can be obtained by using either graft; no statistically significant differences were found in functional outcome between the grafts. PMID:17431619

Sajovic, Matjaz; Strahovnik, Andrej; Komadina, Radko; Dernovsek, Mojca Z

2007-03-13

364

Relationship between Static Anterior Laxity Using the KT-1000 and Dynamic Tibial Rotation during Motion in Patients with Anatomical Anterior Cruciate Ligament Reconstruction.  

PubMed

The anterior cruciate ligament (ACL) plays an important role in controlling knee joint stability, not only by limiting tibial anterior translation but also by controlling knee axial rotation. The aim of ACL reconstruction is to reduce excessive anterior joint laxity, hoping to restore normal tibiofemoral kinematics including knee axial rotation. The purpose of this study was to investigate the relationship between static anterior instability and tibial rotation during several activities in an anterior cruciate ligament reconstructed knee. Seven patients with unilateral ACL injury performed plain walking, running, landing and side step cutting tasks after ACL reconstruction with a mean follow-up of 14 months. The kinematic data for the 4 motions was measured using a motion analysis system and the point cluster technique. The evaluation period was defined to be from the first contact to removal of the tested leg from the ground. Maximum tibial internal rotation during tasks was calculated using the point cluster technique (PCT). Passive anterior tibial translation was measured using a KT-1000 arthrometer. Regression analysis was used to determine the correlation of the maximum internal rotation with the side-to-side difference of static anterior tibial translation measured using a KT-1000 arthrometer. During side step cutting maneuvers, maximum tibial internal rotation significantly showed negative correlation with static anterior tibial translation (p<0.05, r=0.83). The anterior laxity contributed to the normal knee rotation kinematics. The normal anterior tibial translation obtained by ACL reconstruction is thought to be the key factor in successful restoration of normal knee kinematics. PMID:23925154

Sato, Koji; Maeda, Akira; Takano, Yoshio; Matsuse, Hiroo; Ida, Hirofumi; Shiba, Naoto

2013-08-07

365

Anterior cruciate ligament reconstruction in a patient with Athetoid cerebral palsy: a case report  

PubMed Central

Recent years have seen ACL reconstruction performed in a broad range of patients, regardless of age, sex or occupation, thanks to great advances in surgical techniques, instrumentation and the basic research. Favorable results have been reported; however, we have not been able to locate any reports describing ACL reconstruction in patients with athetoid cerebral palsy. We present herein a previously unreported anterior cruciate ligament (ACL) reconstruction performed in a patient with athetoid cerebral palsy. The patient was a 25-year-old woman with level II athetoid cerebral palsy according to the Gross Motor Function Classification System. She initially injured her right knee after falling off a bicycle. Two years later, she again experienced right-knee pain and a feeling of instability. A right-knee ACL tear and avulsion fracture was diagnosed upon physical examination and confirmed with magnetic resonance imaging (MRI) and X-ray examination at that time. An ACL reconstruction using an autologous hamstring double-bundle graft was performed for recurrent instability nine years after the initial injury. Cast immobilization was provided for 3 weeks following surgery and knee extension was restricted for 3 months with the functional ACL brace to prevent hyperextension due to involuntary movement. Partial weight-bearing was started 1 week postoperatively, with full weight-bearing after 4 weeks. The anterior drawer stress radiography showed a 63% anterior displacement of the involved tibia on the femur six months following the surgery, while the contralateral knee demonstrated a 60% anterior displacement of the tibia. The functional ACL functional brace was then removed. A second-look arthroscopy was performed 13 months after the ACL reconstruction, and both the anteromedial and posterolateral bundles were in excellent position as per Kondo’s criteria. The Lachman and pivot shift test performed under anesthesia were also negative. An anterior drawer stress radiography of the involved knee at 36 months following surgery showed a 61% anterior translation of the tibia. The preoperative symptoms of instability resolved and the patient expressed a high degree of satisfaction with the result of her surgery.

2012-01-01

366

Roentgenographic measurement study for locating femoral insertion site of anterior cruciate ligament: a cadaveric study with X-Caliper  

Microsoft Academic Search

The purpose of this study was to determine the relationships of the anterior cruciate ligament (ACL) femoral insertion site\\u000a with femoral bony landmarks and develop a new method of location. Sixteen unpaired normal Chinese human cadaveric knees were\\u000a used. Femoral insertion sites of the ACL were marked with metal wires. Four pairs of bony landmarks were selected: anatomical\\u000a axis of

Lin Guo; Liu Yang; Ai-min Wang; Xiao-yu Wang; Gang Dai

2009-01-01

367

A radiographic analysis of the relationship between the size and shape of the intercondylar notch and anterior cruciate ligament injury  

Microsoft Academic Search

Notch-view radiographs were obtained from 108 persons with anterior cruciate ligament (ACL) injuries (55 women, 53 men) and 186 with intact ACL (94 women, 92 men). Notch width, femur width, and notch width index were determined from each of the 294 radiographs. The notch was also categorized as either A-shaped or non-A-shaped. Intrarater and interrater reliability ranged from 0.82 to

Mary L. Ireland; Bryon T. Ballantyne; Kristin Little; Irene S. McClay

2001-01-01

368

A Randomized Controlled Trial Comparing the Effectiveness of Functional Knee Brace and Neoprene Sleeve Use After Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Background: Despite a lack of evidence for their effectiveness, functional knee braces are commonly prescribed to patients after anterior cruciate ligament (ACL) reconstruction.Purpose: This trial was conducted to compare postoperative outcomes in patients using an ACL functional knee brace and patients using a neoprene knee sleeve.Hypothesis: Patients using a brace will have superior outcomes than those using a sleeve.Study Design:

Trevor B. Birmingham; Dianne M. Bryant; J. Robert Giffin; Robert B. Litchfield; John F. Kramer; Allan Donner; Peter J. Fowler

2008-01-01

369

Assessment of functional knee bracing: an in vivo three-dimensional kinematic analysis of the anterior cruciate deficient knee  

Microsoft Academic Search

Objective. To describe three-dimensional tibial and femoral movements in vivo and examine the effect of a brace on knee kinematics during moderate to intense activity.Design. Skeletal kinematics of anterior cruciate ligament deficient knees was measured with and without braces during moderate to intense activity.Background. Invasive markers implanted into the tibia and femur are the most accurate means to directly measure

Dan K Ramsey; Mario Lamontagne; Per F Wretenberg; Anders Valentin; Björn Engström; Gunnar Németh

2001-01-01

370

Mechanical properties of biodegradable poly-l-lactide ligament augmentation device in experimental anterior cruciate ligament reconstruction  

Microsoft Academic Search

The mechanical properties, including maximum load, elongation, and axial rigidity, of the biodegradable poly-l-lactic acid (PLLA) ligament augmentation device were investigated, 6, 12, 24, and 48 weeks after experimental anterior cruciate ligament (ACL) repair in 32 sheep. In 16 sheep the cut ACL was removed and reconstructed with the fascia lata augmented with a braided PLLA implant 3.2 mm in

O. Laitinen; T. Pohjonen; P. Törmälä; K. Saarelainen; J. Vasenius; P. Rokkanen; S. Vainionpää

1993-01-01

371

Proprioceptive skills and functional outcome after anterior cruciate ligament reconstruction with a bone–tendon–bone graft  

Microsoft Academic Search

Several studies have shown that patients with anterior cruciate ligament (ACL) reconstruction have an improved proprioceptive\\u000a function compared to subjects with ACL-deficient knees. The measurement of functional scores and proprioception potentially\\u000a provides clinicians with more information on the status of the ACL-reconstructed knees. To evaluate proprioception in patients\\u000a following ACL reconstruction with a bone–tendon–bone (BTB) graft, we used the angle

J. O. Anders; R. A. Venbrocks; M. Weinberg

2008-01-01

372

Tissue response to a braided poly-L-lactide implant in an experimental reconstruction of anterior cruciate ligament  

Microsoft Academic Search

During follow-up periods of 6, 12, 24 and 48 weeks, the tissue response to a braided poly-L-lactide (PLLA) implant, 3.2 mm in diameter, was investigated in the reconstruction of experimental anterior cruciate ligament (ACL) ruptures in 32 sheep. In 16 sheep the cut ACL was removed and reconstructed with the fascia lata augmented with a PLLA implant. In 16 sheep

O. Laitinen; I. Alitalo; T. Toivonen; J. Vasenius; P. Törmälä; S. Vainionpää

1993-01-01

373

Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes  

Microsoft Academic Search

We report on 22 patients with chronic grade-2 valgus laxity of the knee combined with chronic anterior cruciate ligament (ACL)\\u000a insufficiency, in whom the two lesions were addressed at the same surgical setting. At a minimum follow-up of 24 months, clinical\\u000a and functional variables had improved significantly (P < 0.001), and 20 of the 22 patients (91%) had returned to sport at pre-injury

Leonardo OstiRocco; Rocco Papalia; Angelo Del Buono; Franco Merlo; Vincenzo Denaro; Nicola Maffulli

2010-01-01

374

Cartilage Injury After Acute, Isolated Anterior Cruciate Ligament Tear: Immediate and Longitudinal Effect With Clinical\\/MRI Follow-up  

Microsoft Academic Search

Background: Anterior cruciate ligament (ACL) tears have been implicated in the development of osteoarthritis. Limited data exist on longitudinal follow-up of isolated ACL injury.Hypotheses: All isolated ACL tears are associated with some degree of cartilage injury that will deteriorate over time. There is a threshold of magnetic resonance imaging (MRI)–detectable cartilage injury that will correlate with adverse change in subjective

Hollis G. Potter; Sapna K. Jain; Yan Ma; Brandon R. Black; Sebastian Fung; Stephen Lyman

2012-01-01

375

Radiographic and intraoperative intercondylar notch width measurements in men and women with unilateral and bilateral anterior cruciate ligament tears  

Microsoft Academic Search

The purpose of this study was to compare the measurements of the intercondylar notch width (NW) in men and women radiographically\\u000a and intraoperatively, and to determine if the radiograph would demonstrate a difference in the patients with unilateral and\\u000a bilateral anterior cruciate ligament (ACL) tears compared with non-injured patients. The control groups consisted of 100 men\\u000a and 100 women from

K. Donald Shelbourne; William A. Facibene; Jeremy J. Hunt

1997-01-01

376

Evaluation of functional deficits determined by four different hop tests in patients with anterior cruciate ligament deficiency  

Microsoft Academic Search

The purpose of this study was to analyze the validity of the newly designed functional ability test (FAT) for the normal\\u000a population and patients with deficiency of the anterior cruciate ligament (ACL). The FAT consists of four tests: the figure-of-eight\\u000a hop, the up-down hop, the side hop, and the single hop. Sixty control subjects and 50 patients with unilateral ACL

Hiromitsu Itoh; Masahiro Kurosaka; Shinichi Yoshiya; Noriaki Ichihashi; Kosaku Mizuno

1998-01-01

377

Differences in kinematics of single leg squatting between anterior cruciate ligament-injured patients and healthy controls  

Microsoft Academic Search

Seventy to eighty percent of all anterior cruciate ligament (ACL) injuries are due to non-contact injury mechanisms. It has\\u000a been reported that the majority of injuries due to single leg landing come from valgus positioning of the lower leg. Preventing\\u000a valgus positioning during single leg landing is expected to help reduce the number of ACL injuries. We found that many

J. Yamazaki; T. Muneta; Y. J. Ju; I. Sekiya

2010-01-01

378

Jump Landing Strategies in Male and Female College Athletes and the Implications of Such Strategies for Anterior Cruciate Ligament Injury  

Microsoft Academic Search

Background: Female athletes are more likely than male athletes to injure the anterior cruciate ligament. Causes of this increased injury incidence in female athletes remain unclear, despite numerous investigations.Hypothesis: Female athletes will exhibit lower hamstring muscle activation and smaller knee flexion angles than male athletes during jump landings, especially when the knee muscles are fatigued.Study Design: Controlled laboratory study.Methods: Eight

Ray Fagenbaum; Warren G. Darling

2003-01-01

379

Anterior Cruciate Ligament Injury in National Collegiate Athletic Association Basketball and SoccerA 13Year Review  

Microsoft Academic Search

Background: Female collegiate athletes have been reported to have a higher rate of anterior cruciate ligament injury compared to male collegiate athletes. This finding has spawned a branch of research focused on understanding and preventing this injury pattern.Purpose: To determine if the trends reported in 1994 have continuedStudy Type: Descriptive epidemiology studyMethods: The National Collegiate Athletic Association Injury Surveillance System

Julie Agel; Elizabeth A. Arendt; Boris Bershadsky

2005-01-01

380

A knee-specific finite element analysis of the human anterior cruciate ligament impingement against the femoral intercondylar notch  

Microsoft Academic Search

This work presents a finite element analysis of anterior cruciate ligament (ACL) impingement against the intercondylar notch during tibial external rotation and abduction, as a mechanism of noncontact ACL injuries. Experimentally, ACL impingement was measured in a cadaveric knee in terms of impingement contact pressure and six degrees-of-freedom tibiofemoral kinematics. Three-dimensional geometries of the ACL, femur and tibia were incorporated

Hyung-Soon Park; Chulhyun Ahn; David T. Fung; Yupeng Ren; Li-Qun Zhang

2010-01-01

381

Risk factors for Anterior Cruciate Ligament injury in skeletally immature patients: analysis of intercondylar notch width using Magnetic Resonance Imaging  

Microsoft Academic Search

The necessity for identification of risk factors for Anterior Cruciate Ligament, ACL injury has challenged many investigators.\\u000a Many authors have reported lower Notch Width Index, NWI measured on radiographs in patients with midsubstance ACL lesions\\u000a compared to control groups. Since a narrow intercondylar notch has been implicated as a possible risk factor related to ACL\\u000a injury we decided to compare

Marcin Domzalski; Piotr Grzelak; Peter Gabos

2010-01-01

382

Matrix metalloproteinase genes on chromosome 11q22 and the risk of anterior cruciate ligament (ACL) rupture  

Microsoft Academic Search

BackgroundAnterior cruciate ligament (ACL) rupture is a complex disorder for which several risk factors, including genetic factors, have been established.ObjectiveAs matrix metalloproteinases (MMPs) are critical to ligament homeostasis and integrity, the primary aim of this study was to investigate if four selected polymorphisms within four MMP genes, which cluster on chromosome 11q22, associate with risk of ACL ruptures.Methods343 (138 individuals

M Posthumus; M Collins; L Van Der Merwe; D OCuinneagain; W Van Der Merwe; W J Ribbans; M P Schwellnus; S M Raleigh

2011-01-01

383

Combined glucosamine and chondroitin sulfate provides functional and structural benefit in the anterior cruciate ligament transection model  

Microsoft Academic Search

Evidence that combined glucosamine sulfate and chondroitin sulfate (Gluchon) or isolated glucosamine (Glu) modifies joint\\u000a damage in osteoarthritis (OA) is still lacking. We studied joint pain and cartilage damage using the anterior cruciate ligament\\u000a transection (ACLT) model. Wistar rats were subjected to ACLT of the right knee (OA) or sham operation. Groups received either\\u000a Glu (500 mg\\/kg), Gluchon (500 mg\\/kg glucosamine +400 mg\\/kg

Francisco Saraiva Silva Jr; Natalino Hajime Yoshinari; Rondinelle Ribeiro Castro; Virgínia Cláudia Carneiro Girão; Margarida Maria Lima Pompeu; Judith Pessoa de Andrade Feitosa; Francisco Airton Castro Rocha

2009-01-01

384

Effect of basic fibroblast growth factor on the healing of defects in the canine anterior cruciate ligament  

Microsoft Academic Search

The effect of basic fibroblast growth factor (bFGF) on the healing of partial anterior cruciate ligament (ACL) lacerations\\u000a was investigated in 17 adult mongrel canines. The defect was created in the midsubstance of both ACLs using a biopsy punch.\\u000a In the bFGF group, a bFGF-impregnated pellet was sutured to the infrapatellar fat pad close to the defect. In the control

D. Kobayashi; M. Kurosaka; S. Yoshiya; K. Mizuno

1997-01-01

385

Pain and fracture after anterior cruciate ligament reconstruction caused by giant cell tumour of the distal femur.  

PubMed

The causes of pain after an anterior cruciate ligament (ACL) reconstruction are numerous and may have complex origins. We present an unusual case in which pain after an ACL reconstruction developed secondary to a giant cell tumour of the bone occurring around a fixation screw in the distal femur, with an associated fracture through the femoral tunnel of a previously well-functioning reconstruction. We discuss the aetiology and the treatment of a complex clinical scenario. PMID:24072827

Dowen, Daniel; Kakkar, Rahul; Dildey, Petra; Gerrand, Craig

2013-09-26

386

Activity Level and Graft Type as Risk Factors for Anterior Cruciate Ligament Graft FailureA Case-Control Study  

Microsoft Academic Search

Background: Anterior cruciate ligament (ACL) graft failure is an uncommon but devastating event after reconstruction, and risk factors for graft failure are not well understood.Hypothesis: Returning to a high activity level after ACL reconstruction and use of an allograft are risk factors for ACL graft failure.Study Design: Case-control study; Level of evidence, 3.Methods: Twenty-one patients with ACL graft failure were

James R. Borchers; Angela Pedroza; Christopher Kaeding

2009-01-01

387

Osteointegration of soft tissue grafts within the bone tunnels in anterior cruciate ligament reconstruction can be enhanced  

Microsoft Academic Search

Anterior cruciate ligament reconstruction with a soft tissue autograft (hamstring autograft) has grown in popularity in the\\u000a last 10 years. However, the issues of a relatively long healing time and an inferior histological healing result in terms\\u000a of Sharpey-like fibers connection in soft tissue grafts are still unsolved. To obtain a promising outcome in the long run,\\u000a prompt osteointegration of the

Guan-Ming Kuang; W. P. Yau; William W. Lu; K. Y. Chiu

2010-01-01

388

Anterior Cruciate Ligament Failure and Cartilage Damage During Knee Joint CompressionA Preliminary Study Based on the Porcine Model  

Microsoft Academic Search

Background: Anterior cruciate ligament (ACL) injury incurred from high-impact activities leads to an increased risk of osteoarthritis.Hypothesis: Impact forces that cause ACL failure can also inflict cartilage damage, whereby its extent and distribution may be influenced by the ligament failure mechanism.Study Design: Descriptive laboratory study.Methods: Six porcine knee specimens were mounted to a material testing system at 70° of flexion.

Chen Hua Yeow; Chee Hoong Cheong; Kian Siang Ng; Peter Vee Sin Lee; James Cho Hong Goh

2008-01-01

389

Repair of a complete anterior cruciate tear using prolotherapy: a case report  

PubMed Central

Objective and Importance Surgical reconstruction is considered definitive treatment for anterior cruciate ligament (ACL) tears but precise surgical indications are debated. Some patients are reluctant or inappropriate surgical candidates. Prolotherapy is a non-surgical injection therapy for chronic musculoskeletal pain and instability. This case report documents the non-surgical repair of a torn ACL using prolotherapy and at-home exercise. Clinical Presentation and Intervention The 18 year old female patient sustained a right knee injury during a downhill skiing accident. Magnetic Resonance Imaging (MRI) revealed a high-grade partial versus complete rupture; Lachman exam findings suggested a complete rupture. She deferred surgical treatment. At 21 weeks post-injury, with unstable gait, inability to climb stairs and more than 1 cm anterior drawer test, she consented to undergo prolotherapy injections. She received 7 prolotherapy sessions over a 15 week period. At-home exercises were initiated at the 3rd prolotherapy session. Results The patient improved. Walking on flat ground improved 4 weeks after initiation of prolotherapy; she could ride a stationary bicycle for 30 minutes by 12 weeks. By 15 weeks, the patient had no instability climbing and descending stairs, the anterior drawer test was negative and MRI showed an intact ACL with fibrosis. Subsequently, she returned to full sport activity. Conclusions We document the non-surgical repair of a high-grade partial or complete ACL tear using prolotherapy and at-home exercise. Prolotherapy may be an alternative to surgery in carefully selected patients. This report is consistent with findings of recent pilot-level studies and suggests the need for rigorous clinical trials assessing prolotherapy as treatment for ligament and tendon injury in selected patients.

Grote, Walter; Delucia, Rosa; Waxman, Robert; Zgierska, Aleksandra; Wilson, John; Rabago, David

2010-01-01

390

Repair of a complete anterior cruciate tear using prolotherapy: a case report.  

PubMed

OBJECTIVE AND IMPORTANCE: Surgical reconstruction is considered definitive treatment for anterior cruciate ligament (ACL) tears but precise surgical indications are debated. Some patients are reluctant or inappropriate surgical candidates. Prolotherapy is a non-surgical injection therapy for chronic musculoskeletal pain and instability. This case report documents the non-surgical repair of a torn ACL using prolotherapy and at-home exercise. CLINICAL PRESENTATION AND INTERVENTION: The 18 year old female patient sustained a right knee injury during a downhill skiing accident. Magnetic Resonance Imaging (MRI) revealed a high-grade partial versus complete rupture; Lachman exam findings suggested a complete rupture. She deferred surgical treatment. At 21 weeks post-injury, with unstable gait, inability to climb stairs and more than 1 cm anterior drawer test, she consented to undergo prolotherapy injections. She received 7 prolotherapy sessions over a 15 week period. At-home exercises were initiated at the 3(rd) prolotherapy session. RESULTS: The patient improved. Walking on flat ground improved 4 weeks after initiation of prolotherapy; she could ride a stationary bicycle for 30 minutes by 12 weeks. By 15 weeks, the patient had no instability climbing and descending stairs, the anterior drawer test was negative and MRI showed an intact ACL with fibrosis. Subsequently, she returned to full sport activity. CONCLUSIONS: We document the non-surgical repair of a high-grade partial or complete ACL tear using prolotherapy and at-home exercise. Prolotherapy may be an alternative to surgery in carefully selected patients. This report is consistent with findings of recent pilot-level studies and suggests the need for rigorous clinical trials assessing prolotherapy as treatment for ligament and tendon injury in selected patients. PMID:20802815

Grote, Walter; Delucia, Rosa; Waxman, Robert; Zgierska, Aleksandra; Wilson, John; Rabago, David

2009-12-01

391

Three-Dimensional Characterization of the Anterior Cruciate Ligament's Femoral Footprint.  

PubMed

There is increasing use of three-dimensional (3D) computed tomography (CT) for researching anterior cruciate ligament (ACL) reconstructions and tunnel placement. However, there is limited 3D CT data on the ACL footprint. The purpose of this study is to define the native ACL femoral footprint using 3D surface reconstructions of computed tomography (CT) imaging of cadaveric knees. The femoral insertion of the ACL was meticulously dissected and marked with drill holes in seven cadaveric knees. CT scans were performed on each specimen, and 3D computer models were created. Distance from the condyle edges to the margins of the footprint were referenced to the total condylar size. This was performed both parallel and perpendicular to the femoral axis as well as the intercondylar notch. The mean condylar depth (c/C) ratios along the axis of the femur were 0.45 ± 0.06 for the anterior border, 0.44 ± 0.08 for the posterior border, 0.26 ± 0.07 for the proximal border, and 0.63 ± 0.08 for the distal border. The mean notch (n/N) ratios for the four margins were 0.37 ± 0.04 for the anterior border, 0.67 ± 0.08 for the posterior border, 0.49 ± 0.07 for the proximal margin, and 0.50 ± 0.06 for the distal border. The mean c/C ratios parallel the intercondylar notch measured 0.23 ± 0.03 for the anterior border, 0.27 ± 0.04 for the posterior border, 0.37 ± 0.04 for the proximal border, and 0.12 ± 0.02 for the distal border. The mean n/N ratios perpendicular to the intercondylar notch measured 0.11 ± 0.06 for the anterior border, 0.52 ± 0.09 the posterior border, 0.29 ± 0.06 for the proximal border, and 0.30 ± 0.06 for the distal border. This study provides reference measures of the femoral footprint of the ACL using 3D CT. It will assist future studies that use advanced imaging to evaluate accuracy of ACL reconstruction. PMID:23765876

Westermann, Robert; Sybrowsky, Christian; Ramme, Austin; Amedola, Annuziati; Wolf, Brian R

2013-06-13

392

Hamstrings Stiffness and Landing Biomechanics Linked to Anterior Cruciate Ligament Loading.  

PubMed

Context : Greater hamstrings stiffness is associated with less anterior tibial translation during controlled perturbations. However, it is unclear how hamstrings stiffness influences anterior cruciate ligament (ACL) loading mechanisms during dynamic tasks. Objective : To evaluate the influence of hamstrings stiffness on landing biomechanics related to ACL injury. Design : Cross-sectional study. Setting : Research laboratory. Patients or Other Participants : A total of 36 healthy, physically active volunteers (18 men, 18 women; age = 23 ± 3 years, height = 1.8 ± 0.1 m, mass = 73.1 ± 16.6 kg). Intervention(s) : Hamstrings stiffness was quantified via the damped oscillatory technique. Three-dimensional lower extremity kinematics and kinetics were captured during a double-legged jump-landing task via a 3-dimensional motion-capture system interfaced with a force plate. Landing biomechanics were compared between groups displaying high and low hamstrings stiffness via independent-samples t tests. Main Outcome Measure(s) : Hamstrings stiffness was normalized to body mass (N/m·kg(-1)). Peak knee-flexion and -valgus angles, vertical and posterior ground reaction forces, anterior tibial shear force, internal knee-extension and -varus moments, and knee-flexion angles at the instants of each peak kinetic variable were identified during the landing task. Forces were normalized to body weight, whereas moments were normalized to the product of weight and height. Results : Internal knee-varus moment was 3.6 times smaller in the high-stiffness group (t22 = 2.221, P = .02). A trend in the data also indicated that peak anterior tibial shear force was 1.1 times smaller in the high-stiffness group (t22 = 1.537, P = .07). The high-stiffness group also demonstrated greater knee flexion at the instants of peak anterior tibial shear force and internal knee-extension and -varus moments (t22 range = 1.729-2.224, P < .05). Conclusions : Greater hamstrings stiffness was associated with landing biomechanics consistent with less ACL loading and injury risk. Musculotendinous stiffness is a modifiable characteristic; thus exercises that enhance hamstrings stiffness may be important additions to ACL injury-prevention programs. PMID:23768123

Blackburn, J Troy; Norcross, Marc F; Cannon, Lindsey N; Zinder, Steven M

2013-06-14

393

Rye grass is associated with fewer non-contact anterior cruciate ligament injuries than bermuda grass  

PubMed Central

Objective: To assess the contribution of ground variables including grass type to the rate of anterior cruciate ligament (ACL) injury in the Australian Football League (AFL), specifically which factors are primarily responsible for previously observed warm season and early season biases for ACL injuries. Methods: Grass types used at the major AFL venues from 1992 to 2004 were established by consultation with ground managers, and ground hardness and other weather variables were measured prospectively. Results: There were 115 ACL injuries occurring in matches during the survey time period, 88 with a non-contact mechanism. In multivariate analysis, use of bermuda (couch) grass as opposed to rye grass, higher grade of match, and earlier stage of the season were independent risk factors for non-contact ACL injury. Ground hardness readings did not show a significant association with ACL injury risk, whereas weather variables of high evaporation and low prior rainfall showed univariate association with injury risk but could not be entered into a logistic regression equation. Discussion: Rye grass appears to offer protection against ACL injury compared with bermuda (couch) grass fields. The likely mechanism is reduced "trapping" of football boots by less thatch. Grass species as a single consideration cannot fully explain the ACL early season bias, but is probably responsible for the warm season bias seen in the AFL. Weather variables previously identified as predictors are probably markers for predominance of bermuda over rye grass in mixed fields.

Orchard, J; Chivers, I; Aldous, D; Bennell, K; Seward, H

2005-01-01

394

A multilayer braided scaffold for Anterior Cruciate Ligament: mechanical modeling at the fiber scale.  

PubMed

An adapted scaffold for Anterior Cruciate Ligament (ACL) tissue engineering must match biological, morphological and biomechanical requirements. Computer-aided tissue engineering consists of finding the most appropriate scaffold regarding a specific application by using numerical tools. In the present study, the biomechanical behavior of a new multilayer braided scaffold adapted to computer-aided tissue engineering is computed by using a dedicated Finite Element (FE) code. Among different copoly(lactic acid-co-(?-caprolactone)) (PLCL) fibers tested in the present study, PLCL fibers with a lactic acid/?-caprolactone ratio of 85/15 were selected as a constitutive material for the scaffold considering its strength and deformability. The mechanical behavior of these fibers was utilized as material input in a Finite Element (FE) code which considers contact/friction interactions between fibers within a large deformation framework. An initial geometry issued from the braiding process was then computed and was found to be representative of the actual scaffold geometry. Comparisons between simulated tensile tests and experimental data show that the method enables to predict the tensile response of the multilayer braided scaffold as a function of different process parameters. As a result, the present approach constitutes a valuable tool in order to determine the configuration which best fits the biomechanical requirements needed to restore the knee function during the rehabilitation period. The developed approach also allows the mechanical stimuli due to external loading to be quantified, and will be used to perform further mechanobiological analyses of the scaffold under dynamic culture. PMID:22836026

Laurent, Cédric P; Durville, Damien; Mainard, Didier; Ganghoffer, Jean-François; Rahouadj, Rachid

2012-03-24

395

Anterior cruciate ligament reconstruction with synthetic grafts. A review of literature  

PubMed Central

Anterior cruciate ligament (ACL) rupture, one of the most common knee injuries in sports, results in anteroposterior laxity, which often leads to an unstable knee. Traditional ACL reconstruction is performed with autograft; disadvantages of this technique are donor site morbidity and a long rehabilitation period. In the 1980s, artificial ligaments became an attractive alternative to biological grafts. The initial enthusiasm surrounding their introduction stemmed from their lack of donor morbidity, their abundant supply and significant strength, immediate loading and reduced postoperative rehabilitation. Synthetic grafts made of different materials such as carbon fibers, polypropylene, Dacron and polyester have been utilised either as a prosthesis or as an augmentation for a biological ACL graft substitute. Nevertheless, every material presented serious drawbacks: cross-infections, immunological responses, breakage, debris dispersion leading to synovitis, chronic effusions, recurrent instability and knee osteoarthritis. Recently, a resurgence of interest in the use of synthetic prostheses has occurred and studies regarding new artificial grafts have been reported. Although many experimental studies have been made and much effort has been put forth, currently no ideal prosthesis mimicking natural human tissue has been found.

Ventura, Alberto; Terzaghi, Clara; Borgo, Enrico; Albisetti, Walter

2010-01-01

396

Telemetry system for monitoring anterior cruciate ligament graft forces in vivo.  

PubMed

Quantifying changes in the tension of an anterior cruciate ligament (ACL) graft in vivo during rehabilitative exercises is useful for developing the optimum rehabilitation for patients who have had reconstructive surgery. The purpose of the work reported is to design, build and test a telemetry system that can measure the in vivo ACL graft tension post-operatively. A commercially available fixation device is modified to sense the graft tension, house electronic components, transmit an output signal and pass the power generating signal. A transcutaneous inductive link is used to power the implanted telemetry electronics. The current difference technique is used to measure changes in two resistance strain gauges that monitor shear strain developed on the femoral fixation device by the ACL graft. This current regulates a frequency-modulated output signal that is transmitted using a new technique. Harnessing the ionic and volume conduction properties of the body fluids, the new technique involves injecting current subcutaneously into the tissue and then sensing the potential developed on the skin by surface electrodes. The waveform shape, amount of charge injected, charge density and current density are regulated to avoid tissue damage, pain and unwanted muscular stimulation. A signal conditioning board detects and converts the output to an analogue voltage for collection by a computer data-acquisition system. A performance evaluation demonstrates that the telemetry system either meets or exceeds all of the criteria necessary for the application. PMID:9747573

McKee, E L; Lindsey, D P; Hull, M L; Howell, S M

1998-05-01

397

Optimal graft length for anterior cruciate ligament reconstruction: a biomechanical study in beagles.  

PubMed

The anterior cruciate ligament (ACL) is a major ligament that helps maintain the stability of the knee joint. Injury to the ACL can be treated by replacing the torn ligament. This study determined the optimal flexor tendon length in the bone tunnel in ACL reconstruction.Autologous ACL reconstruction was performed using a flexor tendon in 54 male beagles, with the graft length in the bone tunnel at 5, 9, 13, 17, 21, and 25 mm (9 dogs per graft length). The maximum tensile strength and stiffness of the reconstructed joint (tibia-ACL-femur triad) were recorded at 45, 90, and 180 days after ACL reconstruction (6 joints per time point). The experiment also included an intact control group (3 dogs) and a control group tested immediately after the reconstruction (3 dogs). For the intact control group, the normal ACL (unreconstructed) and flexor tendon mechanical testing was performed. For the other control group, the normal ACL (unreconstructed) mechanical testing was performed first and then mechanical testing of the specimens was performed immediately after reconstruction. The maximum tensile strength and stiffness of the reconstructed tibia-ACL-femur triad increased with time after reconstruction, regardless of the graft length in the bone tunnel. Maximum tensile strength and stiffness of the grafts increased with graft length but reached a plateau at 17 mm. Optimal strength and stiffness of the reconstructed ACL are achieved with 17-mm grafts. PMID:23672910

Yuan, Feng; Zhou, Wei; Cai, Junfeng; Zhao, Jinzhong; Huangfu, Xiaoqiao; Yin, Feng

2013-05-01

398

Biology of anterior cruciate ligament injury and repair: Kappa delta ann doner vaughn award paper 2013.  

PubMed

Anterior cruciate ligament (ACL) injuries are currently treated by removing the injured ligament and replacing it with a tendon graft. Recent studies have examined alternative treatment methods, including repair and regeneration of the injured ligament. In order to make such an approach feasible, a basic understanding of ACL biology and its response to injury is needed. Identification of obstacles to native ACL healing can then be identified and potentially resolved using tissue engineering strategies-first, with in vitro screening assays, and then with in vivo models of efficacy and safety. This Perspectives paper outlines this path of discovery for optimizing ACL healing using a bio-enhanced repair technique. This journey required constructing indices of the functional tissue response, pioneering physiologically based methods of biomechanical testing, developing, and validating clinically relevant animal models, and creating and optimizing translationally feasible scaffolds, surgical techniques, and biologic additives. Using this systematic translational approach, "bio-enhanced" ACL repair has been advanced to the point where it may become an option for future treatment of acute ACL injuries and the prevention of subsequent post-traumatic osteoarthritis associated with this injury. © 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:1501-1506, 2013. PMID:23818453

Murray, Martha Meaney; Fleming, Braden C

2013-07-01

399

Patellar tendon ossification after anterior cruciate ligament reconstruction using bone - patellar tendon - bone autograft  

PubMed Central

Background Among the various complications described in literature, the patellar tendon ossification is an uncommon occurrence in anterior cruciate ligament (ACL) reconstruction using bone – patellar tendon – bone graft (BPTB). The heterotopic ossification is linked to knee traumatism, intramedullary nailing of the tibia and after partial patellectomy, but only two cases of this event linked to ACL surgery have been reported in literature. Case presentation We present a case of a 42-year-old Caucasian man affected by symptomatic extended heterotopic ossification of patellar tendon after 20 months from ACL reconstruction using BPTB. The clinical diagnosis was confirmed by Ultrasound, X-Ray and Computed Tomography studies, blood tests were performed to exclude metabolic diseases then the surgical removal of the lesion was performed. After three years from surgery, the patient did not report femoro-patellar pain, there was not range of motion limitation and the clinical-radiological examinations resulted negative. Conclusion The surgical removal of the ossifications followed by anti-inflammatory therapy, seems to be useful in order to relieve pain and to prevent relapses. Moreover, a thorough cleaning of the patellar tendon may reveal useful, in order to prevent bone fragments remain inside it and to reduce patellar tendon heterotopic ossification risk.

2013-01-01

400

Anterior cruciate ligament reconstruction in patients with open physes: early outcomes.  

PubMed

Both nonoperative and operative treatments for anterior cruciate ligament (ACL) deficient knees in skeletally immature patients have reported potentially negative outcomes. This study describes primary ACL reconstruction patients with open physes and their concurrent injuries and evaluates whether these patients are at a higher early risk of revision and reoperation than closed physes patients. A retrospective analysis of prospectively collected data was performed. Patients were identified using an ACL Reconstruction Registry. Summary statistics comparing open and closed physes patients of similar ages in regard to patient characteristics and incidence of early revision and reoperation are provided. Adjusted Cox regression models assessed risk of early revision and reoperation for open physes patients. Of 1,867 patients identified, 232 (12.4%) patients had open physes and 1,635 (87.6%) patients had closed physes. Patients with open physes were younger, less likely to be women, and had less medial meniscal injuries than closed physes patients. No significant differences were observed in cartilage injury, overall menisci injury and repair, and early revision and reoperation rate. According to the our results, no significant differences in risk of early revision or early reoperation in open physes compared with closed physes patients when adjusting for age were observed, nor were there any reoperations for physeal closure. PMID:23288740

Csintalan, Rick P; Inacio, Maria C S; Desmond, Jamie L; Funahashi, Tadashi T

2012-11-06

401

Growth Factors and Stem Cells for the Management of Anterior Cruciate Ligament Tears  

PubMed Central

The anterior cruciate ligament (ACL) is fundamental for the knee joint stability. ACL tears are frequent, especially during sport activities, occurring mainly in young and active patients. Nowadays, the gold standard for the management of ACL tears remains the surgical reconstruction with autografts or allografts. New strategies are being developed to resolve the problems of ligament grafting and promote a physiological healing process of ligamentous tissue without requiring surgical reconstruction. Moreover, these strategies can be applicable in association surgical reconstruction and may be useful to promote and accelerate the healing process. The use of growth factors and stem cells seems to offer a new and fascinating solution for the management of ACL tears. The injection of stem cell and/or growth factors in the site of ligamentous injury can potentially enhance the repair process of the physiological tissue. These procedures are still at their infancy, and more in vivo and in vitro studies are required to clarify the molecular pathways and effectiveness of growth factors and stem cells therapy for the management of ACL tears. This review aims to summarize the current knowledge in the field of growth factors and stem cells for the management of ACL tears.

Rizzello, Giacomo; Longo, Umile Giuseppe; Petrillo, Stefano; Lamberti, Alfredo; Khan, Wasim Sardar; Maffulli, Nicola; Denaro, Vincenzo

2012-01-01

402

Anterior Cruciate Ligament Changes in Human Joint in Aging and Osteoarthritis  

PubMed Central

Objective The development and patterns of spontaneous aging-related changes in the anterior cruciate ligament (ACL) and their relationship to articular cartilage degeneration are not well characterized. The aim of this study was to investigate the types and temporal sequence of aging-related ACL changes and establish the correlation with cartilage lesion patterns at all stages of OA development in human knee joints without prior joint trauma. Methods Human knee joints (n=120; 65 donors; age 23-92) were obtained at autopsy and ACL and cartilage were graded macroscopically and histologically. Inflammation surrounding the ACL was assessed separately. Results Histological ACL substance scores and ligament sheath inflammation scores increased with aging. Collagen fiber disorganization was the earliest and most prevalent change. The severity of mucoid degeneration and chondroid metaplasia in the ACL increased with development of cartilage lesions. A correlation between ACL and cartilage degeneration was observed, especially in the medial compartment of the knee joint. Conclusion ACL degeneration is highly prevalent in knees with cartilage defects, and may even precede cartilage changes. Hence, ACL deficiencies may not only be important in post-traumatic OA, but also a feature associated with knee OA pathogenesis in general.

Hasegawa, Akihiko; Otsuki, Shuhei; Pauli, Chantal; Miyaki, Shigeru; Patil, Shantanu; Steklov, Nikolai; Kinoshita, Mitsuo; Koziol, James; D'Lima, Darryl D.; Lotz, Martin K.

2011-01-01

403

[Subsequent treatment of surgically managed, fresh, anterior cruciate ligament ruptures--a randomized, prospective study].  

PubMed

The prospective study examined two different postoperative treatments on 46 patients with acute and isolated disruption of the anterior cruciate ligament (acl), who were treated with reconstruction and augmentation using the semitendinosus-tendon. The patients were randomised and divided into two groups either to use a postoperative brace (Donjoy Ind.) set at full extension (group A) or to use the same brace set at a flexion of 20 degrees (group B) on the first 3 days after surgery. All patients undertook a standard "accelerated" rehabilitation protocol and were evaluated after 3, 6 and 12 months after surgery. The results were as follow: the patients of group A reached the full extension faster than group B without any loss of knee stability. Postoperative extension even led to an earlier return to work and sport activities. The muscle strength side-to-side difference (Cybex-measurement) was lower in group A. The severity and intensity of postoperative pain, swelling and giving-way was reduced in group A as was the risk of arthrofibrosis. Evaluated with the scoring scales of the "Orthopädische Arbeitsgruppe Knie" (OAK), the "International Knee Documentation Committee" (IKDC), the Tegner activity score and the Lysholm score, the clinical outcome and activity-level were higher in group A than in group B. This prospective study shows, that immediate postoperative extension, compared to the postoperative flexion of 20 degrees, reduces the term of rehabilitation and optimizes the operative results after acl-reconstruction. PMID:16167266

Pförringer, W; Kremer, C

2005-09-01

404

Four-strand hamstring tendon autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction.  

PubMed

This retrospective study compared the results after anterior cruciate ligament (ACL) reconstruction using a four-strand hamstring tendon graft (4SHG) versus Ligament Advanced Reinforcement System (LARS) artificial ligament in 60 patients between January 2003 and July 2004 with a minimum four-year follow-up. The KT-1000 examination, the International Knee Documentation Committee (IKDC) scoring systems and Lysholm knee scoring scale were used to evaluate the clinical results. The mean side-to-side difference was 2.4 +/- 0.5 mm and 1.2 +/- 0.3 mm in the 4SHG group and LARS group, respectively (P = 0.013). Although other results of ACL reconstruction, measured by IKDC evaluation, Lysholm scores and Tegner scores, showed using a LARS graft clinically tended to be superior to using a 4SHG, there were no significant differences calculated. Our results suggest that four years after ACL reconstruction using a LARS ligament or 4SHG dramatically improves the function outcome, while the patients in the LARS group displayed a higher knee stability than those in the 4SHG group. PMID:19396441

Liu, Zhong-tang; Zhang, Xian-long; Jiang, Yao; Zeng, Bing-Fang

2009-04-25

405

Stability comparison of anterior cruciate ligament between double- and single-bundle reconstructions  

PubMed Central

The purpose of this study was to evaluate the intra-operative stability during double-bundle anterior cruciate ligament (ACL) reconstructions (20 knees) using a navigation system and compare the results with those obtained from single-bundle reconstructions (20 knees). After registering the reference points during ACL reconstruction, antero-posterior and rotational stability tests with 30° knee flexion using a navigation system were measured before and after reconstructions on both groups. The change of antero-posterior translation after and before reconstruction was 12.5 mm in the double-bundle group and 10.5 mm in the single-bundle group, showing significant inter-group difference (p=0.014, from 17.5 mm to 5.1 mm in the double-bundle and from 16.6 mm to 6.1 mm in the single-bundle group). The mean rotational stability of the double-bundle group also showed more significant improvement after reconstruction compared to that of the single-bundle group (9.8° in the double- and 5.6° in the single-bundle groups, p<0.001). These findings suggest that a double-bundle ACL reconstruction restores greater knee stability with respect to the antero-posterior and rotational stability than a single-bundle reconstruction.

Seon, Jong Keun; Park, Sang Jin; Lee, Keun Bae; Yoon, Taek Rim; Seo, Hyoung Yeon

2008-01-01

406

Evidence to support the interpretation and use of the anatomic anterior cruciate ligament reconstruction checklist.  

PubMed

Published papers on anatomic anterior cruciate ligament (ACL) reconstruction often lack details in the description of the surgical procedure, and there are large variations in anatomic ACL reconstruction techniques. We aimed to develop a validated checklist to be used for anatomic ACL reconstruction. First, a list of all potential items that could be used in the checklist was generated. Thirty-four ACL experts were selected to participate in an anonymous online survey to rate the importance of these items on a scale of 1 to 4 (with a score of 4 having the most importance). The results were verified by surveying a large sample of 959 orthopaedic specialists who are peer reviewers for four major orthopaedic journals. Items were included in the final checklist if they received an importance score of 3 or 4 from at least 75% of the survey takers. The survey response rate was 79% (twenty-seven of thirty-four) of the ACL experts and 40% (379 of 959) of the peer reviewers. The final Anatomic ACL Reconstruction Checklist includes seventeen items with a maximum score of 19 points. The final checklist underwent preliminary testing for internal consistency, intertester reliability, and validity. Cronbach's alpha for internal consistency was 0.82, and the intraclass correlation coefficient (ICC) for intertester reliability was 0.65. This large survey-based study on anatomic ACL reconstruction resulted in the development of the Anatomic ACL Reconstruction Checklist; preliminary evidence for interpretation of the scores is provided. PMID:24132368

van Eck, Carola F; Gravare-Silbernagel, Karin; Samuelsson, Kristian; Musahl, Volker; van Dijk, C Niek; Karlsson, Jon; Irrgang, James J; Fu, Freddie H

2013-10-16

407

Current practice variations in the management of anterior cruciate ligament injuries in Croatia  

PubMed Central

AIM: To investigate current preferences and opinions on the diagnosis, treatment and rehabilitation of patients with anterior cruciate ligament (ACL) injury in Croatia. METHODS: The survey was conducted using a questionnaire which was sent by e-mail to all 189 members of the Croatian Orthopaedic and Traumatology Association. Only respondents who had performed at least one ACL reconstruction during 2011 were asked to fill out the questionnaire. RESULTS: Thirty nine surgeons responded to the survey. Nearly all participants (95%) used semitendinosus/gracilis tendon autograft for reconstruction and only 5% used bone-patellar tendon-bone autograft. No other graft type had been used. The accessory anteromedial portal was preferred over the transtibial approach (67% vs 33%). Suspensory fixation was the most common graft fixation method (62%) for the femoral side, followed by the cross-pin (33%) and bioabsorbable interference screw (5%). Almost all respondents (97%) used a bioabsorbable interference screw for tibial side graft fixation. CONCLUSION: The results show that ACL reconstruction surgery in Croatia is in step with the recommendations from latest world literature.

Mahnik, Alan; Mahnik, Silvija; Dimnjakovic, Damjan; Curic, Stjepan; Smoljanovic, Tomislav; Bojanic, Ivan

2013-01-01

408

All-epiphyseal, all-inside anterior cruciate ligament reconstruction technique for skeletally immature patients.  

PubMed

Anterior cruciate ligament (ACL) injuries are an increasingly recognized problem in the juvenile population. Unfortunately, outcomes with conservative treatment are extremely poor. Adult reconstruction techniques are inappropriate to treat skeletally immature patients because of the risk of physeal complications, including limb-length discrepancy and angular deformities. "Physeal-sparing" reconstruction techniques exist, but their ability to restore knee stability is not well understood. We describe an all-epiphyseal ACL reconstruction for use in skeletally immature patients. This is an all-inside technique with the femoral tunnel drilled retrograde and the tibial tunnel drilled retrograde; both tunnels are entirely within the epiphysis. Fixation of the hamstring autograft is achieved with soft-tissue buttons on both the femur and tibia. We present case examples for 2 patients who underwent the all-inside, all-epiphyseal reconstruction and our postoperative rehabilitation protocol. We present a novel surgical technique for an all-inside, all-epiphyseal ACL reconstruction in skeletally immature patients. PMID:23767001

McCarthy, Moira M; Graziano, Jessica; Green, Daniel W; Cordasco, Frank A

2012-11-22

409

Time-dependent gene expression and immunohistochemical analysis of the injured anterior cruciate ligament  

PubMed Central

Objectives This study aimed to investigate time-dependent gene expression of injured human anterior cruciate ligament (ACL), and to evaluate the histological changes of the ACL remnant in terms of cellular characterisation. Methods Injured human ACL tissues were harvested from 105 patients undergoing primary ACL reconstruction and divided into four phases based on the period from injury to surgery. Phase I was < three weeks, phase II was three to eight weeks, phase III was eight to 20 weeks, and phase IV was ? 21 weeks. Gene expressions of these tissues were analysed in each phase by quantitative real-time polymerase chain reaction using selected markers (collagen types 1 and 3, biglycan, decorin, ?-smooth muscle actin, IL-6, TGF-?1, MMP-1, MMP-2 and TIMP-1). Immunohistochemical staining was also performed using primary antibodies against CD68, CD55, Stat3 and phosphorylated-Stat3 (P-Stat3). Results Expression of IL-6 was mainly seen in phases I, II and III, collagen type 1 in phase II, MMP-1, 2 in phase III, and decorin, TGF-?1 and ?-smooth muscle actin in phase IV. Histologically, degradation and scar formation were seen in the ACL remnant after phase III. The numbers of CD55 and P-Stat3 positive cells were elevated from phase II to phase III. Conclusions Elevated cell numbers including P-Stat3 positive cells were not related to collagens but to MMPs’ expressions.

Naraoka, T.; Ishibashi, Y.; Tsuda, E.; Yamamoto, Y.; Kusumi, T.; Kakizaki, I.; Toh, S.

2012-01-01

410

Anterior cruciate ligament reconstruction with synthetic grafts. A review of literature.  

PubMed

Anterior cruciate ligament (ACL) rupture, one of the most common knee injuries in sports, results in anteroposterior laxity, which often leads to an unstable knee. Traditional ACL reconstruction is performed with autograft; disadvantages of this technique are donor site morbidity and a long rehabilitation period. In the 1980s, artificial ligaments became an attractive alternative to biological grafts. The initial enthusiasm surrounding their introduction stemmed from their lack of donor morbidity, their abundant supply and significant strength, immediate loading and reduced postoperative rehabilitation. Synthetic grafts made of different materials such as carbon fibers, polypropylene, Dacron and polyester have been utilised either as a prosthesis or as an augmentation for a biological ACL graft substitute. Nevertheless, every material presented serious drawbacks: cross-infections, immunological responses, breakage, debris dispersion leading to synovitis, chronic effusions, recurrent instability and knee osteoarthritis. Recently, a resurgence of interest in the use of synthetic prostheses has occurred and studies regarding new artificial grafts have been reported. Although many experimental studies have been made and much effort has been put forth, currently no ideal prosthesis mimicking natural human tissue has been found. PMID:20157811

Legnani, Claudio; Ventura, Alberto; Terzaghi, Clara; Borgo, Enrico; Albisetti, Walter

2010-02-16

411

Functional Outcome of Transphyseal Reconstruction of the Anterior Cruciate Ligament in Skeletally Immature Patients  

PubMed Central

Purpose In anterior cruciate ligament (ACL) injury, conventional adult reconstruction techniques have to face the potential risk of growth disturbance or angular deformities in skeletally immature patients. The aim of this study was to evaluate the clinical outcomes of ACL reconstruction by conventional transphyseal tunnel technique. Materials and Methods On a retrospective basis, we reviewed 25 skeletally immature patients; all the patients showed skeletal maturity at last follow-up, and the mean age was 16.4 years. The average injury to surgery interval was 12.6 months. Clinical outcomes were assessed at a mean of 74.4 months postoperatively using the Lysholm Knee Scoring Scale, the Tegner activity level, the International Knee Documentation Committee (IKDC), and plain radiographs. Results All the patients had undergone transphyseal reconstruction of ACL. The mean Lysholm score was 48.36 points preoperatively and 93.32 points postoperatively; the mean Tegner activity level was changed from 3.0 points to 5.6 points. The mean IKDC level was categorized as C preoperatively and changed to A postoperatively. Conclusions Our midterm outcome at an average 6 years after surgery was satisfactory without significant leg length discrepancies or abnormal alignment of the knee joint. Transphyseal reconstruction of ACL is a good treatment modality in the skeletally immature patient.

Kim, Sung-Jae; Shim, Dong-Woo

2012-01-01

412

Assessing post-anterior cruciate ligament reconstruction ambulation using wireless wearable integrated sensors.  

PubMed

Abstract A hardware/software co-design for assessing post-Anterior Cruciate Ligament (ACL) reconstruction ambulation is presented. The knee kinematics and neuromuscular data during walking (2-6?km?h(-1)) have been acquired using wireless wearable motion and electromyography (EMG) sensors, respectively. These signals were integrated by superimposition and mixed signals processing techniques in order to provide visual analyses of bio-signals and identification of the recovery progress of subjects. Monitoring overlapped signals simultaneously helps in detecting variability and correlation of knee joint dynamics and muscles activities for an individual subject as well as for a group. The recovery stages of subjects have been identified based on combined features (knee flexion/extension and EMG signals) using an adaptive neuro-fuzzy inference system (ANFIS). The proposed system has been validated for 28 test subjects (healthy and ACL-reconstructed). Results of ANFIS showed that the ambulation data can be used to distinguish subjects at different levels of recuperation after ACL reconstruction. PMID:24117351

Arosha Senanayake, S M N; Ahmed Malik, Owais; Mohammad Iskandar, Pg; Zaheer, Dansih

2013-10-14

413

Rationale and Clinical Techniques for Anterior Cruciate Ligament Injury Prevention Among Female Athletes  

PubMed Central

Objective: To present the rationale and detailed techniques for the application of exercises targeted to prevent anterior cruciate ligament (ACL) injury in high-risk female athletes. Background: Female athletes have a 4- to 6-fold increased risk for ACL injury compared with their male counterparts playing at similar levels in the same sports. The increased ACL injury risk coupled with greater sports participation by young women over the last 30 years (9-fold increase in high school and 5-fold increase in collegiate sports) has generated public awareness and fueled several sex-related mechanistic and interventional investigations. These investigations provide the groundwork for the development of neuromuscular training aimed at targeting identified neuromuscular imbalances to decrease ACL injury risk. Description: After the onset of puberty, female athletes may not have a neuromuscular spurt to match their similar, rapid increase in growth and development. The lack of a natural neuromuscular adaptation may facilitate the development of neuromuscular imbalances that increase the risk for ACL injury. Dynamic neuromuscular analysis training provides the methodologic approach for identifying high-risk individuals and the basis of using interventions targeted to their specific needs. Clinical Advantages: Dynamic neuromuscular training applied to the high-risk population may decrease ACL injury risk and help more female athletes enjoy the benefits of sports participation without the long-term disabilities associated with injury.

Myer, Gregory D; Ford, Kevin R; Hewett, Timothy E

2004-01-01

414

Foreign body reaction to a bioabsorbable interference screw after anterior cruciate ligament reconstruction  

PubMed Central

Bioabsorbable interference screws have been effective for graft fixation in anterior cruciate ligament (ACL) reconstruction. The overall complication rate associated with the use of these screws is low but some unique problems have been reported in the literature. We present a case of unusual tissue reaction to a bioabsorbable interference screw following ACL reconstruction. A young male underwent ACL reconstruction, during which a bioabsorbable interference screw was used for graft fixation at the tibial end. The patient presented with a pretibial swelling at 30 months after the operation. Exploration revealed chalky white remnants of the bioabsorbable screw with no evidence of infection. Histological studies confirmed a foreign body reaction against screw remnants with the presence of multinucleated giant cells. The patient had a full recovery with no compromise to graft stability. Bioabsorbable interference screws are usually inert but can initiate a tissue reaction. The presentation can be as late as 2–3 years postoperatively and may mimic an infection. Satisfactory results can be achieved by proper exploration and debridement.

Umar, Muhammad; Baqai, Nadeem; Peck, Christopher

2009-01-01

415

Side-to-Side Differences in Anterior Cruciate Ligament Volume in Healthy Control Subjects  

PubMed Central

Examination of anterior cruciate ligament (ACL) anatomy is of great interest both in studying injury mechanisms and surgical reconstruction. However, after a typical acute ACL rupture it is not possible to measure the dimensions of the ACL itself due to concomitant or subsequent degeneration of the remaining ligamentous tissue. The contralateral ACL may be an appropriate surrogate for measuring anatomical dimensions, but it remains unknown whether side-to-side differences preclude using the contralateral as a valid surrogate for the ruptured ACL. This study examined whether the ACL volume is significantly different between the left and right knees of uninjured subjects. ACL volumes were calculated for the left and right sides of 28 individuals using a previously-validated MRI-based method. The mean ACL volume was not significantly different (p=0.2331) between the two sides in this population. Side-to-side ACL volume was also well correlated (correlation=0.91, p<0.0001). The results of this study show that the volume of the contralateral ACL is a valid surrogate measure for a missing ACL on the injured side. This non-invasive, in vivo technique for measuring ACL volume may prove useful in future large-scale comprehensive studies of potential risk factors for ACL rupture, in quantification potential loading effects on ACL size as a prophylactic measure against ACL rupture, and in the use of ACL volume as a screening tool for assessing risk of injury.

Jamison, S T; Flanigan, D C; Nagaraja, H N; Chaudhari, A M W

2009-01-01

416

Role of Myostatin (GDF-8) Signaling in the Human Anterior Cruciate Ligament  

PubMed Central

Myostatin, also referred to as growth and differentiation factor-8 (GDF-8), is expressed in muscle tissue where it functions to suppress myoblast proliferation and myofiber hypertrophy. Recently, myostatin and its receptor, the type IIB activin receptor (ActRIIB), were detected in the leg tendons of mice, and recombinant myostatin was shown to increase cellular proliferation and the expression of type 1 collagen in primary fibroblasts from mouse tendons. We sought to determine whether myostatin and its receptor were present in human anterior cruciate ligament (ACL) tissue, and if myostatin treatment had any effect on primary ACL fibroblasts. ACL tissue samples were obtained from material discarded during ACL reconstruction surgery. Real-time PCR and immunohistochemistry demonstrate that both myostatin and its receptor are abundant in the human ACL. Primary fibroblasts isolated from human ACL specimens were treated with recombinant myostatin, and myostatin treatment increased fibroblast proliferation as well as the expression of tenascin C, type 1 collagen, and transforming growth factor-?1. Real-time PCR analysis of tenascin C and type 1 collagen expression in ACL specimens from normal mice and mice lacking myostatin supported these findings by showing that both tenascin C and type 1 collagen were downregulated in ACL tissue from myostatin-deficient mice. Together, these data suggest that myostatin is a pro-fibrogenic factor that enhances cellular proliferation and extracellular matrix synthesis by ACL fibroblasts. Recombinant myostatin may therefore have therapeutic applications in the area of tendon and ligament engineering and regeneration.

Fulzele, Sadanand; Arounleut, Phonepasong; Cain, Matthew; Herberg, Samuel; Hunter, Monte; Wenger, Karl; Hamrick, Mark W.

2013-01-01

417

Type I collagen and polyvinyl alcohol blend fiber scaffold for anterior cruciate ligament reconstruction.  

PubMed

The aim of this study was to perform an evaluation of a braided fiber scaffold for anterior cruciate ligament (ACL) reconstruction. The scaffold was composed of 50% type I collagen (Col-I) and 50% polyvinyl alcohol (PVA). First, the biocompatibility and in vitro weight loss of the scaffold were tested. Then, the scaffolds were used to reconstruct the ACL in China Bama mimi pigs. At 24 weeks post-operation, the mechanical properties and histology of the regenerated ACL were analyzed. The maximum load and tensile strength were 472.43± 15.2 N and 29.71± 0.96 MPa, respectively; both were ~75% of those of native ACL and ~90% of those of fiber scaffold. This indicated that the scaffold maintained a large portion of native ACL's mechanical properties, and tissue formation on the scaffold compensated most of the tensile strength loss caused by scaffold degradation. Histology and immunohistology analysis showed the morphology and major extracellular matrix components of the regenerated ligament resembled the native ACL. Thus, the Col-I/PVA blend fiber ACL scaffold showed good potential for clinical applications. PMID:23531980

Cai, Changbin; Chen, Cheng; Chen, Guangxing; Wang, Fuyou; Guo, Lin; Yin, Li; Feng, Dehong; Yang, Liu

2013-03-26

418

Telemetry system for monitoring anterior cruciate ligament graft forces in vivo  

NASA Astrophysics Data System (ADS)

Quantifying changes in the tension of an anterior cruciate ligament (ACL) graft in vivo during rehabilitative exercises is vital for developing the optimal rehabilitation for patients who have had reconstructive surgery. The purpose of this project was to design, built, and test a telemetry system that can measure the in vivo ACL graft tension postoperatively. A commercially available fixation device was modified to sense the graft tension, house electronic components, transmit an output signal, and pass the power generating signal. A transcutaneous inductive link was used to power the implanted telemetry electronics. The current difference technique was used to measure changes in two strain gages that monitored shear strain developed on the femoral fixation device by the ACL graft. This current regulated a frequency modulated output signal and transmitted it, by using the ionic properties of body tissue as the medium, to external EMG surface electrodes. A signal conditioning board detected and converted the output to an analog voltage for collection by a computer data acquisition system. A performance evaluation demonstrated that the telemetry system either met or exceeded al of the criteria necessary for the application.

McKee, Eric L.; Hull, Maury L.; Howell, Stephen M.

1997-02-01

419

Bone-patellar tendon-bone autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction.  

PubMed

The optimized graft for use in anterior cruciate ligament (ACL) reconstruction is still in controversy. The bone-patellar tendon-bone (BPTB) autograft has been accepted as the gold standard for ACL reconstruction. However, donor site morbidities cannot be avoided after this treatment. The artificial ligament of ligament advanced reinforcement system (LARS) has been recommended for ACL reconstruction. The purpose of this study is to compare the midterm outcome of ACL reconstruction using BPTB autografts or LARS ligaments. Between July 2004 and March 2006, the ACL reconstruction using BPTB autografts in 30 patients and LARS ligaments in 32 patients was performed. All patients were followed up for at least 4 years and evaluated using the Lysholm knee score, Tegner score, International Knee Documentation Committee (IKDC) score, and KT-1000 arthrometer test. There were no significant differences between the two groups with respect to the data of Lysholm scores, Tegner scores, IKDC scores, and KT-1000 arthrometer test at the latest follow-up. Our study demonstrates that the similarly good clinical results are obtained after ACL reconstruction using BPTB autografts or LARS ligaments at midterm follow-up. In addition to BPTB autografts, the LARS ligament may be a satisfactory treatment option for ACL rupture. PMID:23412205

Pan, Xiaoyun; Wen, Hong; Wang, Lide; Ge, Tichi

2012-09-19

420

Evaluation of manual test for anterior cruciate ligament injury using a body-mounted sensor  

NASA Astrophysics Data System (ADS)

Diagnosis method of anterior cruciate ligament (ACL) using body-mounted sensor is discussed. A wide variety of diagnosis method such as Pivot Shift Test (PST), Lachman Test and monitoring of jump motion (JT) are applied to examine the injured ACL. These methods, however, depend on the ability and the experience of examiner. The proposed method numerically provides three dimensional translation and rotation of the knee by using a newly developed 3D sensor. The 3D sensor is composed of three accelerometers and three gyroscopes. Measured acceleration of the knee during the examination is converted to the fixed system of coordinate according the acceleration of gravity and 3D rotation of the sensor, and is numerically integrated to derive 3D trajectory and rotation angle around the tibia. The experimental results of JT suggest that unsymmetrical movement of rotation angle of the tibia and sudden movement of estimated 3D trajectory show instability of knee joint. From the results of PST analysis, it is observed that the tibial angular velocity around the flexed position changes 41.6 [deg/s] at the injured side and 21.7 [deg/s] at the intact side. This result suggests the reposition of injured knee from subluxation.

Yoshida, R.; Sagawa, K.; Tsukamoto, T.; Ishibashi, Y.

2007-12-01

421

The impact of tensioning device mal-positioning on strand tension during Anterior Cruciate Ligament reconstruction  

PubMed Central

Background In order to confer optimal strength and stiffness to the graft in Anterior Cruciate Ligament (ACL) reconstruction, the maintenance of equal strand tension prior to fixation, is desired; positioning of the tensioning device can significantly affect strand tension This study aimed to determine the effect of tensioning device mal-positioning on individual strand tension in simulated cadaveric ACL reconstructions. Methods Twenty cadaveric specimens, comprising bovine tibia and tendon harvested from sheep, were used to simulate ACL reconstruction with a looped four-strand tendon graft. A proprietary tensioning device was used to tension the graft during tibial component fixation with graft tension recorded using load cells. The effects of the tensioning device at extreme angles, and in various locking states, was evaluated. Results Strand tension varied significantly when the tensioning device was held at extreme angles (p < 0.001) or in 'locked' configurations of the tensioning device (p < 0.046). Tendon position also produced significant effects (p < 0.016) on the resultant strand tension. Conclusion An even distribution of tension among individual graft strands is obtained by maintaining the tensioning device in an unlocked state, aligned with the longitudinal axis of the tibial tunnel. If the maintenance of equal strand tension during tibial fixation of grafts is important, close attention must be paid to positioning of the tensioning device in order to optimize the resultant graft tension and, by implication, the strength and stiffness of the graft and ultimately, surgical outcome.

2011-01-01

422

An in vitro assay of anterior cruciate ligament (ACL) and medial collateral ligament (MCL) cell migration.  

PubMed

Explants from rabbit anterior cruciate ligaments (ACL) and medial collateral ligaments (MCL) were utilized to compare the relative rates that fibroblasts migrate onto glass and plastic culture surfaces in vitro. During the first two weeks in culture, a monolayer of cells appeared on the periphery of all the ACL and MCL explants. From 45 to 134 hrs in culture, the mean total MCL cell count per explant was 6-12 times greater than that for the ACL on the plastic culture dishes, and this difference was even greater for the cells attached to the glass cover slides over the explants. These differences were significant at the p < .005 level. The rates of cell proliferation were quite similar for primary cultures of ACL and MCL grown in the same medium as that used for the migration assay. The large difference in cell number at early times of culture is thus due to the more rapid MCL cell migration out of the explants, and not to a difference in the rate of cell proliferation. These data support the hypothesis that differences in cell migration rate play a role in the greater healing capacity of the MCL as compared with the ACL. The assay described in this work may then be useful in assessing factors that promote wound healing. PMID:8039388

Geiger, M H; Green, M H; Monosov, A; Akeson, W H; Amiel, D

1994-01-01

423

Reconstruction of the anterior cruciate ligament: association of graft choice with increased risk of early revision.  

PubMed

We examined the association of graft type with the risk of early revision of primary anterior cruciate ligament reconstruction (ACLR) in a community-based sample. A retrospective analysis of a cohort of 9817 ACLRs recorded in an ACLR Registry was performed. Patients were included if they underwent primary ACLR with bone-patellar tendon-bone autograft, hamstring tendon autograft or allograft tissue. Aseptic failure was the main endpoint of the study. After adjusting for age, gender, ethnicity, and body mass index, allografts had a 3.02 times (95% confidence interval (CI) 1.93 to 4.72) higher risk of aseptic revision than bone-patellar tendon-bone autografts (p < 0.001). Hamstring tendon autografts had a 1.82 times (95% CI 1.10 to 3.00) higher risk of revision compared with bone-patellar tendon-bone autografts (p = 0.019). For each year increase in age, the risk of revision decreased by 7% (95% CI 5 to 9). In gender-specific analyses a 2.26 times (95% CI 1.15 to 4.44) increased risk of hamstring tendon autograft revision in females was observed compared with bone-patellar tendon-bone autograft. We conclude that allograft tissue, hamstring tendon autografts, and younger age may all increase the risk of early revision surgery after ACLR. PMID:23632671

Maletis, G B; Inacio, M C S; Desmond, J L; Funahashi, T T

2013-05-01

424

Proprioceptive changes in the contralateral knee joint following anterior cruciate injury.  

PubMed

Loss of proprioception following an anterior cruciate ligament (ACL) injury has been well documented. We evaluated proprioception in both the injured and the uninjured limb in 25 patients with ACL injury and in 25 healthy controls, as assessed by joint position sense (JPS), the threshold for the detection of passive movement (TDPM) and postural sway during single-limb stance on a force plate. There were significant proprioceptive deficits in both ACL-deficient and uninjured knees compared with control knees, as assessed by the angle reproduction test (on JPS) and postural sway on single limb stance. The degree of loss of proprioception in the ACL-deficient knee and the unaffected contralateral knee joint in the same patient was similar. The TDPM in the injured knee was significantly higher than that of controls at 30° and 70° of flexion. The TDPM of the contralateral knee joint was not significantly different from that in controls. Based on these findings, the effect of proprioceptive training of the contralateral uninjured knee should be explored. PMID:23365027

Arockiaraj, J; Korula, R J; Oommen, A T; Devasahayam, S; Wankhar, S; Velkumar, S; Poonnoose, P M

2013-02-01

425

Repair of a torn medial meniscus with an anteromedial meniscofemoral ligament in an anterior cruciate ligament-injured knee.  

PubMed

We report a rare case of longitudinal tear of the anterior segment of the medial meniscus in association with the anteromedial meniscofemoral ligament (AMMFL) in an anterior cruciate ligament-injured knee. The tear was repaired, and the anterior horn was transferred to the tibia using the pull-out technique after excising the AMMFL. Repeat arthroscopy performed 7 months postoperatively revealed that the medial meniscus had completely healed and the anterior horn was firmly fixed to the tibia. Two years after the surgery, the patient could play basketball without any symptom. A posteroanterior flexion weight-bearing radiograph did not show any narrowing of the medial joint space. Considering the excellent healing observed in this case, preservation of the meniscus should be considered despite an association between a torn meniscus and an anomalous insertion. PMID:21127836

Hamada, Masayuki; Miyama, Takahide; Nagayama, Yoshihiro; Shino, Konsei

2010-12-03

426

A Prospective Study of Prognostic Factors Concerning the Outcome of Arthroscopic Surgery for Anterior Ankle Impingement  

Microsoft Academic Search

Sixty-two consecutive patients with painful limited dor siflexion of the ankle not responding to nonoperative treatment participated in a prospective study. All 42 men and 20 women (average age, 31 years) under went arthroscopic surgery. Preoperative radiographs were graded according to an osteoarthritic and an impingement classification. Standardized followup took place at 4 months and 1 and 2 years after

C. Niek van Dijk; Johannes L. Tol; Cees C. P. M. Verheyen

1997-01-01

427

Evaluation of Kinematics of Anterior Cruciate Ligament-Deficient Knees with Use of Advanced Imaging Techniques, Three-Dimensional Modeling Techniques, and Robotics  

PubMed Central

Measuring knee biomechanics in six degrees of freedom with acceptable accuracy has been proven to be technically challenging. At our bioengineering laboratory, we have employed both an in vitro robotic testing system and an in vivo combined dual fluoroscopic and magnetic resonance imaging technique to analyze the impact of anterior cruciate ligament rupture on the knee joint. When measuring the tibiofemoral kinematics of nine cadavers with the robotic testing system, we found that anterior cruciate ligament deficiency not only altered anterior translation and axial rotation of the tibia, but it also increased the medial translation of the tibia as well. The in vivo dual fluoroscopic imaging analysis of tibiofemoral kinematics in ten anterior cruciate ligament-deficient patients revealed analogous findings: an increased medial translation of the tibia of approximately 1 mm between 15° and 90° of flexion was found in anterior cruciate ligament-deficient knees, in addition to an increased anterior translation (approximately 3 mm) and internal rotation (approximately 2°) of the tibia at low flexion angles. In a subsequent study of tibiofemoral cartilage contact, we found that the cartilage contact points shifted posteriorly—as was expected on the basis of the increased anterior tibial translation—as well as laterally on the surface of the tibial plateau. The data demonstrate how rupture of the anterior cruciate ligament initiates a cascade of events that eventually results in abnormal tibiofemoral cartilage contact in both the anteroposterior and mediolateral directions. If the restoration of normal knee homeostasis is the ultimate goal of ligament reconstruction, the normal function of the anterior cruciate ligament should be restored as closely as possible in all degrees of freedom.

Van de Velde, Samuel K.; Gill, Thomas J.; Li, Guoan

2009-01-01

428

Proximal anterior cruciate ligament tears: the healing response technique versus conservative treatment.  

PubMed

The healing response technique (HRT) is a nonreconstructive method to promote healing in proximal anterior cruciate ligament (ACL) tears. The study reviews clinical and radiological long-term results. Thirty patients (average age 31 years) were treated according to the protocol described by Steadman et al. For comparison, an age- and gender-matched control group of conservatively treated patients (CST; n = 127) was selected. At follow-up (mean: 4 years), all patients were evaluated using Kneelax-3-arthrometer, magnetic resonance imaging (MRI), and by clinical examination. Two HRT patients were lost to follow-up and 10 (36%) patients needed definitive ACL reconstruction. The rate of secondary ACL reconstruction in the initial CST group was 56% (71 of 127). Nineteen of the conservatively treated patients were selected according to above-mentioned criteria. The average Lysholm score in the HRT group was 91 (CST group = 90), and the Orthopaedische Arbeitsgemeinschaft Knie score was 93 (CST group = 92). Tegner score decreased from 6.8 before injury to 5.7 at the time of follow-up (CST group: 6.0 to 5.1). Kneelax-3-arthrometer showed a significant higher anterior knee laxity compared with the noninjured side in both groups. MRI showed improvement of the ACL in both groups. HRT in adult patients is associated with a high revision rate of 36% secondary ACL reconstruction, comparable with primary conservative treatment (p = 0.056). For the remaining patients (64%), HRT did not result in better outcomes than conservative treatment. PMID:23258320

Wasmaier, Johann; Kubik-Huch, Rahel; Pfirrmann, Christian; Grehn, Holger; Bieg, Christian; Eid, Karim

2012-12-20

429

Effect of Perturbing a Simulated Motion on Knee and Anterior Cruciate Ligament Kinetics  

PubMed Central

Current surgical treatments for common knee injuries do not restore the normal biomechanics. Among other factors, the abnormal biomechanics increases the susceptibility to the early onset of osteoarthritis. In pursuit of improving long term outcome, investigators must understand normal knee kinematics and corresponding joint and anterior cruciate ligament (ACL) kinetics during the activities of daily living. Our long term research goal is to measure in vivo joint motions for the ovine stifle model and later simulate these motions with a 6 degree of freedom (DOF) robot to measure the corresponding 3D kinetics of the knee and ACL-only joint. Unfortunately, the motion measurement and motion simulation technologies used for our project have associated errors. The objective of this study was to determine how motion measurement and motion recreation error affect knee and ACL-only joint kinetics by perturbing a simulated in vivo motion in each DOF and measuring the corresponding intact knee and ACL-only joint forces and moments. The normal starting position for the motion was perturbed in each degree of freedom by four levels (?0.50, ?0.25, 0.25, and 0.50 mm or degrees). Only translational perturbations significantly affected the intact knee and ACL-only joint kinetics. The compression-distraction perturbation had the largest effect on intact knee forces and the anterior-posterior perturbation had the largest effect on the ACL forces. Small translational perturbations can significantly alter intact knee and ACL-only joint forces. Thus, translational motion measurement errors must be reduced to provide a more accurate representation of the intact knee and ACL kinetics. To account for the remaining motion measurement and recreation errors, an envelope of forces and moments should be reported. These force and moment ranges will provide valuable functional tissue engineering parameters (FTEPs) that can be used to design more effective ACL treatments.

Herfat, Safa T.; Boguszewski, Daniel V.; Nesbitt, Rebecca J.

2013-01-01

430

Effect of perturbing a simulated motion on knee and anterior cruciate ligament kinetics.  

PubMed

Current surgical treatments for common knee injuries do not restore the normal biomechanics. Among other factors, the abnormal biomechanics increases the susceptibility to the early onset of osteoarthritis. In pursuit of improving long term outcome, investigators must understand normal knee kinematics and corresponding joint and anterior cruciate ligament (ACL) kinetics during the activities of daily living. Our long term research goal is to measure in vivo joint motions for the ovine stifle model and later simulate these motions with a 6 degree of freedom (DOF) robot to measure the corresponding 3D kinetics of the knee and ACL-only joint. Unfortunately, the motion measurement and motion simulation technologies used for our project have associated errors. The objective of this study was to determine how motion measurement and motion recreation error affect knee and ACL-only joint kinetics by perturbing a simulated in vivo motion in each DOF and measuring the corresponding intact knee and ACL-only joint forces and moments. The normal starting position for the motion was perturbed in each degree of freedom by four levels (-0.50, -0.25, 0.25, and 0.50 mm or degrees). Only translational perturbations significantly affected the intact knee and ACL-only joint kinetics. The compression-distraction perturbation had the largest effect on intact knee forces and the anterior-posterior perturbation had the largest effect on the ACL forces. Small translational perturbations can significantly alter intact knee and ACL-only joint forces. Thus, translational motion measurement errors must be reduced to provide a more accurate representation of the intact knee and ACL kinetics. To account for the remaining motion measurement and recreation errors, an envelope of forces and moments should be reported. These force and moment ranges will provide valuable functional tissue engineering parameters (FTEPs) that can be used to design more effective ACL treatments. PMID:23083204

Herfat, Safa T; Boguszewski, Daniel V; Nesbitt, Rebecca J; Shearn, Jason T

2012-10-01

431

Radiographic findings in revision anterior cruciate ligament reconstructions from the Mars cohort.  

PubMed

The Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) group was developed to investigate revision ACL reconstruction outcomes. An important part of this is obtaining and reviewing radiographic studies. The goal for this radiographic analysis is to establish radiographic findings for a large revision ACL cohort to allow comparison with future studies. The study was designed as a cohort study. Various established radiographic parameters were measured by three readers. These included sagittal and coronal femoral and tibial tunnel position, joint space narrowing, and leg alignment. Inter- and intraobserver comparisons were performed. Femoral sagittal position demonstrated 42% were more than 40% anterior to the posterior cortex. On the sagittal tibia tunnel position, 49% demonstrated some impingement on full-extension lateral radiographs. Limb alignment averaged 43% medial to the medial edge of the tibial plateau. On the Rosenberg view (45-degree flexion view), the minimum joint space in the medial compartment averaged 106% of the opposite knee, but it ranged down to a minimum of 4.6%. Lateral compartment narrowing at its minimum on the Rosenberg view averaged 91.2% of the opposite knee, but it ranged down to a minimum of 0.0%. On the coronal view, verticality as measured by the angle from the center of the tibial tunnel aperture to the center of the femoral tunnel aperture measured 15.8 degree ± 6.9% from vertical. This study represents the radiographic findings in the largest revision ACL reconstruction series ever assembled. Findings were generally consistent with those previously demonstrated in the literature. PMID:23404491

2013-02-12

432

Acute torn meniscus combined with acute cruciate ligament injury. Second look arthroscopy after 3-month conservative treatment.  

PubMed

The purpose of this study was to evaluate arthroscopically the natural healing of an acute torn meniscus combined with an acute cruciate ligament injury treated nonoperatively. There were 30 lateral and 10 medial meniscus tears associated with 25 acute anterior cruciate ligament and 7 posterior cruciate ligament injuries in 32 patients. There was more than 1 tear on some menisci for a total of 51 tear sites. Injuries to the menisci and ligaments were allowed to heal without surgery, but were given protective mobilization immediately in order to stimulate stress oriented healing of injured collagen fibers and promote circulation of synovial fluid to the meniscus and ligament. A Kyuro knee brace with a coil spring traction system was used to add adequate but not excessive stress to the associated injured cruciate ligament. All knees were examined and arthroscoped before and after a 3-month treatment period. Results indicated that 69% of the lateral menisci healed completely and 18% healed partially, whereas 58% of the medial menisci healed completely and none healed partially. Twenty of 25 anterior cruciate ligaments and 3 of 7 posterior cruciate ligaments healed satisfactorily. This study indicated that acute tears of the meniscus, even when they occur in association with a cruciate ligament injury, can heal morphologically with nonsurgical treatment. PMID:7924027

Ihara, H; Miwa, M; Takayanagi, K; Nakayama, A

1994-10-01

433

New arthroscopic disc repositioning and suturing technique for treating an anteriorly displaced disc of the temporomandibular joint: part I--technique introduction.  

PubMed

Anterior disc displacement is one of the most frequent types of temporomandibular joint disorders. Various arthroscopic disc repositioning and suturing techniques were reported to treat patients with disc displacement in the 1990s, but the success rate and long-term stability was not satisfactory. This report describes a new repositioning and suturing technique and discusses its advantages and disadvantages. PMID:22771167

Yang, C; Cai, X-Y; Chen, M-J; Zhang, S-Y

2012-07-04

434

Early Results of Concurrent Arthroscopic Repair of Rotator Cuff and Type II Superior Labral Anterior Posterior Tears  

PubMed Central

Background: Recent reports on concurrent arthroscopic rotator cuff and type II superior labral anterior posterior (SLAP) repair have raised concerns over postoperative stiffness and patient satisfaction. However, it is unclear if the observed stiffness relates to the repair of degenerative SLAP tears in older adults, the surgical technique, the postoperative rehabilitation, or to a combination of these factors. Purpose: The purpose of this study was to evaluate the outcome and repair integrity of concurrent arthroscopic rotator cuff and type II SLAP repair. Study Design: Case series. Methods: Of 11 patients identified, 7 had a full-thickness rotator cuff tear and 4 had a high-grade partial thickness tear that was completed. A cannula placed through the rotator cuff tear improved the trajectory for posterior suture anchor placement during SLAP repair. Postoperative rehabilitation employed continuous passive motion to prevent stiffness. Results: At minimum of 1-year follow-up, mean yes responses on the Simple Shoulder Test improved from 5.4 to 10.7 (out of 12; P < .01), and mean American Shoulder and Elbow Surgeons scores improved from 40 to 87 (out of 100; P < .01). Mean forward elevation improved from 148° to 161° (P < .01) and external rotation from 58° to 67° (P < .01). Magnetic resonance imaging, obtained at most recent follow-up in 10 patients, demonstrated a healed SLAP tear in all patients and a persistent rotator cuff defect in 1 patient. Conclusions: Arthroscopic rotator cuff repair can be successfully combined with type II SLAP repair in relatively young patients who have sustained traumatic injury to their shoulders. Allowing early passive motion may help prevent postoperative stiffness without compromising rotator cuff healing.

Strickland, Justin P.; Fleckenstein, Cassie M.; Ducker, Al; Hasan, Samer S.

2010-01-01

435

Healing of the goat anterior cruciate ligament after a new suture repair technique and bioscaffold treatment.  

PubMed

Primary suture repair of the anterior cruciate ligament (ACL) has been used clinically in an attempt to heal the ruptured ACL. The results, however, were not satisfactory, which in retrospect can be attributed to the used suturing technique and the suboptimal healing conditions. These constraining conditions can be improved by introducing a new suturing technique and by using small intestinal submucosa (SIS) as a bioscaffold. It is hypothesized that the suturing technique keep the torn ends together and that SIS enhance and promote the healing of the ACL. The goat was used as the study model. In the Suture group, the left ACL was transected and suture repaired with a new locking suture repair technique (n=5) allowing approximation and fixation under tension. The Suture-SIS group underwent the same procedure with the addition of SIS (n=5). The right ACL served as control. After 12 weeks of healing, anterior-posterior translation and in situ force of the healing ACL were measured, followed by the measurement of the cross-sectional area and structural stiffness. Routine histology was performed on tissue samples. Gross morphology showed that the healing ACL was continuous with collagenous tissue in both groups. The cross-sectional area of the Suture and the Suture-SIS group was 35% and 50% of the intact control, respectively. The anterior-posterior translations at different flexion angles were statistically not different between the Suture group and the Suture-SIS group. Only the in situ force at 30° in the Suture-SIS group was higher than in the Suture group. Tensile tests showed that the stiffness for the Suture group was not different from the Suture-SIS group (31.1±8.1?N/mm vs. 41.9±18.0?N/mm [p>0.05]). Histology showed longitudinally aligned collagen fibers from origo to insertion. More fibroblasts were present in the healing tissue than in the control intact tissue. The study demonstrated the proof of concept of ACL repair in a goat model with a new suture technique and SIS. The mechanical outcome is not worse than previously reported for ACL reconstruction. In conclusion, the approach of using a new suture technique, with or without a bioscaffold to heal the ACL is promising. PMID:23725556

Nguyen, D Tan; Geel, Jurre; Schulze, Martin; Raschke, Michael J; Woo, Savio L-Y; van Dijk, C Niek; Blankevoort, Leendert

2013-07-10

436

A Cadaver Study of the Structures and Positions of the Anterior Cruciate Ligament in Humans  

PubMed Central

Background: The anterior cruciate ligament (ACL) is one of the major knee structures. It consists of anteromedial bundle (AMB) and posterolateral bundle (PLB). Rupture of the ACL is one of the most prevalent traumas among athletes. There are two ways to reconstruct the rupture; Single–bundle and double–bundle (DB) reconstruction. Precise study on bundles anatomy, the exact number of attachments and knee flexion angle with an appropriate place of bundles and also choosing the best angle for the grafts are so important in successful reconstructing of the bundles. In this research, the general attempt was to assess anatomy and the act of the ACL is and bundles in Iranian population. Methods: We obtained twelve fresh-frozen cadaver knees (two females, ten males). The average age of them was 30 years; they were mostly between 27 and 34 years old. Initially, skin, muscles, and patellar and articular capsule were removed. Then, bundle attachments, knee movements in flexion angle, extension and stiffness of both bundles were evaluated. Thereafter, on 0, 30, 60, 90, 120, and 180° angle knee flexion the bundles degree stiffness evaluated in different directions. During the process, to measure bundles size, digital camera for photography, oblique for measuring the angles, and micrometer were utilized. From all next of kin written consent testimonial form was obtained. Results: In all knees, two bundles were identified as distinct. AMB attachment location in the anterior region observed as semi-lunate and in one case, it was rounded. In all cases, two bundles of full knee extension were paralleled, and the AMB was anterior to the PLB; with increasing flexion angle, femoral attachment location of AMB was in back direction and femoral attachment location of PLB moved toward the front direction. Two bundles were in the most amount of cross state, which the angle was 90°. From the stiffness point of view in all 6 samples, the PLB had the most tension in extension state, and the AMB had the most tension in 120° flexion. Conclusion: In the current study, we realized that the ACL is a DB ligament in Iranian population. The AMB in full extension has the least stiffness and in 90° flexion has the most; the PLB also in full knee extension and in 160° flexion has the most and least stiffness, respectively.

Moghaddam, Ahmad Bagheri; Torkaman, Ali

2013-01-01

437

Neuromuscular and biomechanical landing performance subsequent to ipsilateral semitendinosus and gracilis autograft anterior cruciate ligament reconstruction.  

PubMed

The hamstrings musculature is a vital component of an intricate dynamic knee joint restraint mechanism. However, there is evidence based on research studies suggesting potential deficits to this complex mechanism due to donor site morbidity resulting from harvest of the ipsilateral semitendinosus and gracilis autograft (ISGA) for anterior cruciate ligament reconstruction (ACLR). The purpose of this retrospective research study was to investigate the effects of ISGA ACLR on neuromuscular and biomechanical performance during a single-leg vertical drop landing (VDL), a functional task and associated mechanism of anterior cruciate ligament disruption during physical activity. Fourteen physically active participants 22.5 +/- 4.1 years of age and 21.4 +/- 10.7 months post ISGA ACLR underwent bilateral neuromuscular, biomechanical and isokinetic strength and endurance evaluations matched to 14 control participants by sex, age, height and mass. Kinetic and kinematic data was obtained with 3-D motion analyses utilizing inverse dynamics while performing single-leg VDLs from a height of 30 cm. Integrated surface electromyography (SEMG) assessments of the quadriceps, hamstrings and gastrocnemius musculature were also conducted. Additionally, knee joint flexion strength (60 degrees s(-1)) and endurance (240 degrees s(-1)) measurements were tested via isokinetic dynamometry. No significant differences existed in hip and net summated extensor moments within or between groups. The ISGA ACLR participants recorded significantly decreased peak vertical ground reaction force (VGRF) landing upon the involved lower extremity compared to uninvolved (P = 0.028) and matched (P < 0.0001) controls. Participants having undergone ISGA ACLR also displayed greater peak hip joint flexion angles landing upon the involved lower extremity compared to uninvolved (P = 0.020) and matched (P = 0.026) controls at initial ground contact. The ISGA ACLR group furthermore exhibited increased peak hip joint flexion angles landing upon the involved lower extremity compared to uninvolved (P = 0.019) and matched (P = 0.007) controls at peak VGRF. Moreover, ISGA ALCR participants demonstrated greater peak knee (P = 0.005) and ankle (P = 0.017) joint flexion angles when landing upon the involved lower extremity compared to the matched control at peak VGRF. The ISGA ACLR group produced significantly greater reactive muscle activation of the vastus medialis (P = 0.013), vastus lateralis (P = 0.008) and medial hamstrings (P = 0.024) in the involved lower extremity compared to the matched control. The ISGA ACLR participants also exhibited greater preparatory (P = 0.033) and reactive (P = 0.022) co-contraction muscle activity of the quadriceps and hamstrings landing upon the involved lower extremity compared to the matched control. In addition, the ISGA ACLR group produced significantly less preparatory (P = 0.005) and reactive (P = 0.010) muscle activation of the gastrocnemius in the involved lower extremity compared to the uninvolved control. No significant differences were present in hamstrings muscular strength and endurance. Harvest of the ISGA for purposes of ACLR does not appear to result in significant neuromuscular, biomechanical or strength and endurance deficiencies due to donor site morbidity. However, it is evident that this specific population exhibits unique neuromuscular and biomechanical adaptations aimed to stabilize the knee previously subjected to ACL trauma and safeguard the ISGA ACLR joint. Co-contraction of quadriceps and hamstrings as well as inhibition of gastrocnemius muscle activation may serve to moderate excessive loads exposed to the intra-articular ISGA during single-leg VDLs. Furthermore, greater muscle activation of the hamstrings in conjunction with increased peak hip, knee and ankle joint flexion angles may assist in enhancing acceptance of VGRF transferred through the kinetic chain following single-leg VDLs. PMID:17973098

Vairo, Giampietro L; Myers, Joseph B; Sell, Timothy C; Fu, Freddie H; Harner, Christopher D; Lephart, Scott M

2007-11-01

438

Effect of Early and Delayed Mechanical Loading on Tendon-to-Bone Healing After Anterior Cruciate Ligament Reconstruction  

PubMed Central

Background: Modulation of the mechanical environment may profoundly affect the healing tendon graft-bone interface. The purpose of this study was to determine how controlled axial loading after anterior cruciate ligament reconstruction affects tendon-to-bone healing. Our hypothesis was that controlled cyclic axial loading after a period of immobilization would improve tendon-to-bone healing compared with that associated with immediate axial loading or prolonged immobilization. Methods: One hundred and fifty-six male Sprague-Dawley rats underwent anterior cruciate ligament reconstruction with use of a flexor digitorum longus autograft. A custom-designed fixture was used to apply an external fixator across the knee parallel to the anterior cruciate ligament graft. Animals were randomly assigned to be treated with immobilization (n = 36) or controlled knee distraction along the long axis of the graft to achieve approximately 2% axial strain beginning (1) immediately postoperatively (n = 36), (2) on postoperative day 4 (“early delayed loading,” n = 42), or (3) on postoperative day 10 (“late delayed loading,” n = 42). The animals were killed at fourteen or twenty-eight days postoperatively for biomechanical testing, micro-computed tomography, and histomorphometric analysis of the bone-tendon-bone complex. Data were analyzed with use of a two-way analysis of variance followed by a post hoc Tukey test with p < 0.05 defined as significant. Results: Delayed initiation of cyclic axial loading on postoperative day 10 resulted in a load to failure of the femur-anterior cruciate ligament-tibia complex at two weeks that was significantly greater than that resulting from immediate loading or prolonged immobilization of the knee (mean and standard deviation, 9.6 ± 3.3 N versus 4.4 ± 2.3 N and 4.4 ± 1.5 N, respectively; p < 0.01). The new-bone formation observed in the tibial tunnels of the delayed-loading groups was significantly increased compared with that in the immediate-loading and immobilization groups at both two and four weeks postoperatively (1.47 ± 0.11 mm3 [postoperative-day-10 group] versus 0.89 ± 0.30 mm3 and 0.85 ± 0.19 mm3, respectively, at two weeks; p < 0.003). There were significantly fewer ED1+ inflammatory macrophages and significantly more ED2+ resident macrophages at the healing tendon-bone interface in both delayed-loading groups compared with the counts in the immediate-loading and immobilization groups at two and four weeks (2.97 ± 0.7 [postoperative day 10] versus 1.14 ± 0.47 and 1.71 ± 1.5 ED2+ cells, respectively, per high-power field at two weeks; p < 0.02). The numbers of osteoclasts in the delayed-loading groups were significantly lower than those in the immediate-loading and immobilization groups at two and four weeks postoperatively (0.35 ± 0.15 [postoperative-day-10 group] versus 1.02 ± 0.08 and 1.44 ± 0.2 cells, respectively, per high-power field at two weeks; p < 0.01), and the delayed-loading groups also had significantly reduced interface tissue vascularity compared with the other groups (p < 0.003). Conclusions: Delayed application of cyclic axial load after anterior cruciate ligament reconstruction resulted in improved mechanical and biological parameters of tendon-to-bone healing compared with those associated with immediate loading or prolonged postoperative immobilization of the knee. Clinical Relevance: This study of anterior cruciate ligament reconstruction may have important implications for rehabilitation after soft-tissue reconstructive procedures in the knee. Controlled mechanical loads after a delay to allow resolution of acute postoperative inflammation may be most favorable to the healing enthesis.

Bedi, Asheesh; Kovacevic, David; Fox, Alice J.S.; Imhauser, Carl W.; Stasiak, Mark; Packer, Jonathan; Brophy, Robert H.; Deng, Xiang-Hua; Rodeo, Scott A.

2010-01-01

439

Cellular and extracellular matrix changes in anterior cruciate ligaments during human knee aging and osteoarthritis  

PubMed Central

Introduction Anterior cruciate ligament (ACL) degeneration is observed in most osteoarthritis (OA)-affected knee joints. However, the specific spatial and temporal relations of these changes and their association with extracellular matrix (ECM) degeneration are not well understood. The objective of this study was to characterize the patterns and relations of aging-related and OA-associated changes in ACL cells and the ECM. Methods Human knee joints from 80 donors (age 23 through 94) were obtained at autopsy. ACL degeneration was assessed histologically by using a quantitative scoring system. Tissue sections were analyzed for cell density, cell organization, ECM components, ECM-degrading enzymes and markers of differentiation, proliferation, and stem cells. Results Total cell number in normal ACL decreased with aging but increased in degenerated ACL, because of the formation of perivascular cell aggregates and islands of chondrocyte-like cells. Matrix metalloproteinase (MMP)-1, -3, and -13 expression was reduced in aging ACL but increased in degenerated ACL, mainly in the chondrocyte-like cells. Collagen I was expressed throughout normal and degenerated ACL. Collagen II and X were detected only in the areas with chondroid metaplasia, which also expressed collagen III. Sox9, Runt-related transcription factor 2 (Runx2), and scleraxis expression was increased in the chondrocyte-like cells in degenerated ACL. Alpha-smooth muscle actin (?-SMA), a marker of myofibroblasts and the progenitor cell marker STRO-1, decreased with aging in normal ACL. In degenerated ACL, the new cell aggregates were positive for ?-SMA and STRO-1. Conclusions ACL aging is characterized by reduced cell density and activation. In contrast, ACL degeneration is associated with cell recruitment or proliferation, including progenitor cells or myofibroblasts. Abnormally differentiated chondrocyte-like cell aggregates in degenerated ACL produce abnormal ECM and may predispose to mechanical failure.

2013-01-01

440

Clinical Results Comparing Transtibial Technique and Outside in Technique in Single Bundle Anterior Cruciate Ligament Reconstruction  

PubMed Central

Purpose To compare the clinical results of single-bundle anterior cruciate ligament (ACL) reconstruction using the conventional transtibial technique and the anatomical outside-in technique for femoral tunneling. Materials and Methods From 2007 to 2011, 89 patients who received ACL reconstruction were followed for ?1 year were enrolled in the study. The conventional transtibial technique was used in 41 patients and the outside-in technique, in 48 patients. Femoral tunnel angle measurement and three-dimensional computed tomography (3D CT) were used for radiologic assessment of the location of femoral tunnel and Lysholm score and other tests were used for clinical assessment. Results Both techniques did not reveal statistical differences in the clinical assessment. However, in International Knee Documentation Committee subjective knee evaluation, the sum of two questionnaire items regarding instability showed a statistically significant difference (p=0.01). In the pivot shift test, the anatomical outside-in technique showed outstanding rotational stability over the transtibial technique (p=0.04). The mean femoral tunnel inclination in coronal plane were 69.2° and 30.3°, respectively, for both techniques, and 21.6° and 50.8°, respectively in sagittal plane, showing statistically significant differences on simple radiography (p=0.04, 0.05). A 3D CT was performed in 17 patients with the conventional transtibial technique and 25 patients with the outside-in technique. Coefficients of variation were 0.33 and 0.13, respectively, from dorsal border of the condyle and 0.67 and 0.24, respectively, from the roof of intercondylar notch. Conclusions Femoral tunnels created with the outside-in technique have superior knee joint rotational stability compare to the transtibial technique. Therefore, the outside-in technique could be considered as a valuable technique in single-bundle ACL reconstruction.

Seo, Seung Suk; Kim, Jeon Gyo; Jin, Sung Yub

2013-01-01

441

Measurement of normal patellar ligament and anterior cruciate ligament by MRI and data analysis  

PubMed Central

The aim of this study was to obtain geometric data of in vivo patellar ligament (PL) and anterior cruciate ligament (ACL) by MRI and to analyze the correlation of the two with body weight, height and gender. A total of 157 cases with normal sagittal images of bilateral PL and ACL were enrolled. The PL and ACL lengths in the images were measured using the Radworks 5.1 application. The intraclass correlation coefficient for the data measured independently by three doctors was 0.997–1.000. In individuals aged 15–24 years, the values of PL and ACL length and the PL to ACL ratio were 43.95±4.25 mm, 38.45±4.62 mm and 1.15±1.09 in males and 42.03±0.94 mm, 36.00±1.06 mm and 1.18±0.1 in females, respectively. In individuals aged 25–64 years, the values in males were 40.99±4.45 mm, 36.06±3.74 mm and 1.14±0.09 and in females were 39.84±0.64 mm, 36.50±0.81 mm and 1.11±0.02, respectively. In individuals aged ?65 years, the values in males were 41.43±3.08 mm, 36.62±3.44 mm and 1.15±0.09 and in females were 38.94±0.79 mm, 34.36±0.85 mm and 1.13±0.07, respectively. There was a significant difference between PL and ACL length on the same side (P<0.01). The data obtained was stable and repeatable. The present study established a database of PL and ACL length and the ratio of the two measured by MRI.

WANG, HONGPO; HUA, CAIHONG; CUI, HONGKAI; LI, YUXIA; QIN, HAIXIA; HAN, DONGMING; YUE, JUNYAN; LIANG, CHANGHUA; YANG, RUIMIN

2013-01-01

442

Use of CT in the management of anterior cruciate ligament revision surgery.  

PubMed

Anterior cruciate ligament (ACL) injuries occur most commonly in individuals between 18 and 29 years of age and are strongly correlated with sporting activity, with female athletes being at higher risk of ACL rupture than their male counterparts. ACL reconstruction is one of the most frequently performed procedures in orthopaedic surgery, having a reported incidence of 85 per 100,000 head of population in the at-risk age group. Subsequent graft failure is most commonly caused by recurrent trauma, followed by tunnel malpositioning, although the choice of graft type does not appear to affect outcome. The Danish ACL registry reported that ACL revisions accounted for 7.5%